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TA.E..S..w ' PPLICATION FOL. <br /> COT Or CONSTRUCTION Pe <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION 0 BUILDING 0 MECHANICAL 0 PLUMBING 0 SIGN <br /> Cr1YNE A MAR ADORE SS CITY jr[` <br /> PHONE <br /> a'EUE.�it - , S'P/T LII EVEPF7'1 /4L A Ieoc$y J EVEZ'c-77 4J 1 Ei•a K• <br /> AACIIIII CI OR Ct 5AON(A MAIL ADORE SS CITY ANON( <br /> Aii3QT vP_ /// +go7t/ c//41- LI S1 < 7177z •,�,4 <br /> OE NE ALL CCNIRACTOR Mbt ADORE55 C,I Z.I. <br /> �A/�� cDONE /���- I�GEA115[ <br /> • <br /> IE/JE'i c��T Is/ /]rrTYl. 1 2D /Jr ac ,C4'_ N__ Se frIz efl E4 <br /> Mt(I4A'%. AL CONIUACL.N V•'L LOCALSS �� <br /> bry Pr .ONE LICENSE A <br /> /.tsT 4/ET �pfJ6 <br /> PIUMBwri CONT A AC I CW MAIL AOORE55 CITY Zr PHONE LICENSE• <br /> .lh7- YET ter -L=-2> <br /> CLASS Or WOAA <br /> NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 DEMOLITION CI cJOOSTUVE/FRPL.INSERT 0 BUILDING RELOCATION <br /> VAC I.IA rON Or MOAN,COST Of MATE FALL 5 rl US I AAOAI <br /> CCE <br /> t' `/ (va8�LlL19 <br /> D*SCIIIOL*ONK <br /> p l4/..Wr- R fiF".7 �€4ERZ/Z,__6�12$P/T/tL Of EilE�PF-r7- <br /> USE Or&Oa D'NG <br /> IeP/l/tL ✓!S/7�,�,r �T�rf I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL OE SCRIrl ION Or 0ROPERTIISI.0 14 BL.OW On ATTACH f OUACOPIE St PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> LOT_eLxK Gr OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> IN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> IAA <br /> �� GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> SPP (x PIA ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. I//'SIGNA`TURE/Or N R CTCR OR AUTHORIZED AGENT RATE,6/ge <br /> SI <br /> PROJECT AOOwE SS ♦PPL ICANi 1 .gUSINE. 110, <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET,TOILET? AJC-AA-NOLO UNITS-H P <br /> BATHTUB REFRIGERATION UNITS-H P EA <br /> LAVATORY I WASH BASINI BOILERS-B.T U JH P <br /> SHOWER GAS FIRED A C.UNITS-B.T U <br /> KITCHEN SINK I OISP _ FORCED AIR SYSTEMS-B T U M EA <br /> DISHWASHER WALL HEATERS-BTU M <br /> LAUNDRY TRAY UNIT HEATERS-B T U I.! <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHES DRYERS <br /> DRINKING FOUNTAIN VENTILATION.AN <br /> FLOOR DRAIN RANGE HOOD <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ` <br /> ROOF DRAINS-RAINLEADERS WOOD STOVE <br /> SINK I SERVICE -BAR ETC I METAL FIREPLACE a CHIMNEY <br /> FIREPLACE INSERT -• <br /> HEAT PUMP <br /> GAS PIPING <br /> EAHAUST FAN <br /> SUB TOTAL S SUB TOTAL 1 <br /> ►ERWT S <br /> PERMIT 1 <br /> TOTAL FEE S TOTAL FEE I <br /> .RETvr SE'SAC. REAR SE OWN SIDE SE IgAf.I( P'I.AN CHECK NUMBER rFE RECEIPT NO <br /> S�/aoo81 �56dG8 976 7j,LSE LONE i )1 ARIA <br /> VACM1 vTE FEES VALUATION FEE <br /> *E1 10 "� 'I,E.�v <br /> r'f PE Or COYSr xCUPANC•Gn BUILDING $s./�/. (/(y,./ 10 7 5C <br /> QQ our NO OFO*FFLLING UNITS <br /> l l4� lI/ flJ S <br /> P� /5-3 -0-- PLUMBING <br /> -IZE Or�011 DO NO Of Stpw1E1 M••OCC IRAD <br /> />2 yea. 5r4�,�s 7l } MECHANICAL 7�/��/� (/EE'L■, -]✓ /L• Q EO OTHER f. Il i/ L \h (] �) 1 0 <br /> FIRE SPRINKLERS REQUIRED YYES U NO /JIE'�77 ONGy _ STATE BUIIL�_DAAmE!!+//(��SURCHARGE �I�.5/'1 <br /> n STATE ENERGY SURCHARGE �V <br /> a4.1 K,APOtf A:;C A• f PLAIM CHECKED AY APE'S FOR 1151ANCEB• <br /> �/� /� _PUBLIC WORKS <br /> t / / <br /> 4A ill I / TOTAL _�III!!! 7ll <br /> J <br /> !I PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />