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7 <br /> `�� r'�NSTRUCTION /� <br /> everett PERMIT PERMITNQ::� ��`�� , <br /> 259 -8745 <br /> ❑ DEMOLITION ❑ COMBINATION �E3 BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �E3 <br /> OWNER MAiLApORE55 GiTY ZIP FNONE <br /> tIXilBKXdidtXStllti! rrederick Buse 235 81C7t8ii� Bridgewav Everett 96201 252-7946 <br /> ARCMITECTONOESIGNER MRILADDRE55 C�tt "P PNONE <br /> GENERRL WNtNACTON MRIL RO�PE55 QiY ZIC VHONE IICENSE� <br /> owner <br /> MECHANICAL CONiRRCTOR IAAIL RDDRE55 dTY 21P PNONE IICENSE• <br /> PLUMBING CONTRRCTOR MAIL RDDRE55 CITV ZiP PHONE LICENSE• <br /> CLASS OF WORR <br /> ❑ NEW ❑ ADDITION ❑ ALTEPATION G�1 REPAIH O �EMOLITION ❑ BUILDING RELOCATION <br /> VALUATION Of WORK <br /> S 20�0.�0 <br /> OE.SCRIBE WORN <br /> R2IOOE <br /> HEATSOUFCE <br /> ❑ E�ECTRICITY ❑ GAS G WOOUSTOVE ❑ OTHER <br /> PROPOSED USE OF Bl1iLDIN(? <br /> Dwallin I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> g APPLICATION AND KNOW THE SAME TO BE TRUE AND <br /> lEGl1LOE5CRIPTIOUOFPNUPEPTY�SMOWBELOWORATTRCNGOUPCOPIES� CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br /> LOT_BLOCN _ OF GOVERNING THIS TYPE UF WORK WILL BE COMPLIED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br /> PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br /> VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br /> THE PERFORMANCE OF CONSTRUCTION. <br /> JOBRDDRESS � SIGNnTUREOFCONT ACtOR UTIIORIZ[DAG OR014NER OAtE <br /> �3`� �l�l/��f_l( r� X ��J. � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> W ATER CLOSET(TOILET� A/C—AMNDLG UNItS-�HP <br /> BATHTUB REFRIGERATION UNITS—HP.EA. <br /> LAVATORV�WASH BASIN� BOILERS—B.T.U.M.P. <br /> SHOWER GAS FIRED A�C.UNITS—B.T.U. <br /> KITCHEN SINK 8 DISP. FORCED AIR SVSTEMS—B.T.U. M EA. <br /> DISH\NASNER WALL HEATEFS—0 T.U. M <br /> LAl1NDRY TRAY UNIi HEATER$—0 TL. M <br /> CLOTHES WASHER EVAPOHATIVE COOLERS <br /> � URINAL CLOTHES DRYERS <br /> ;RINKING FOUNTAIN VENiILATION FAN <br /> FLOOR D9AIN RANGE HOOD <br /> UACKFLOW PPEVENTERS K'ATER HEATER • <br /> ROOF D(iAINS—flAINLEFDEFS H'OOD STOVE <br /> SIkY.�SEIIVICE—BAfi.ETC.� MEiAL FIREPLACE 8 CHIMNEV <br /> FIREPLACEINSERT <br /> 11EAT VUMP <br /> GAS PIPING <br /> E%HAUSTFAN <br /> SUBTOtAL S SUBTOTAL <br /> PERMIT S PENMIT <br /> TOTALFEE S TOTALFEE <br /> fRpNT SETBACK nEnR sEioncK SiDE SErBacK PLAN CHECN NUMBER FEE RECEIPT NO <br /> USEZONE LOTAqER <br /> VACANTSiTE FEES VALUATION FEE <br /> ❑YES ❑NO <br /> TYi'EOFCONST. OCCUPRNCVGROUP NOOFDWELLiNGUNRS BUILDING �� " ' C1t�S��Q ��R <br /> PLUMBING % <br /> SiZE OF GLOG NO OF STORIE; MA%OCC.LCRD - '-' ' ` <br /> t�UJUtUc '�. <br /> MECHANICAL �4�. ��� <br /> V INVESTIGATIONFEE B '���04(e) $ .�U <br /> FIQESPRINKLERSREOUIRED VES ❑NO C . r �.�U <br /> STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> APPLICATION ACC DY PUNS CNECKEO�Y APPP.FOR ISSUA'10E OV <br /> DRIVEWAY PERMIT <br /> S.H. TOTAL 4G 50 <br /> PENMIT VALIDATION <br /> WHEN PROPERLY VALIDATED(IN THIS SPACE)THI515 YOUR PERMIT <br /> �� <br /> �' <br /> N <br /> � <br /> � <br /> AUGflESS i'l[ <br />