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{ µ, J �-Y,�'�aR TFF�.Y��. , .�r . ��n . ^a. �:.�� L <br /> � �PPLICATI� 'FORsCONSTRUC�ON PERMIT � <br /> �, � . . <br /> '��,�- . everett <br /> everett e <br /> ' BUILDING DEPARTMENT <br /> 259-B810 TO 8E COMPLETED IN INK—PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING 35 SIGN <br /> OWIER � r MAILADDRESS CITV 21P PMONE <br /> j X . OT�✓r�' //✓/(/ Fi��2E7T liY.1� , <br /> � TEIMNT MAILAJORE55 GI7Y 21P PHONE ', j' <br /> � MiCHITECTOi1DE610NER MA�L/1DDRE55 GITY 21P PHONE ' <br /> �� A,�.fE,2/�,v�(/EAU D. o. �x 43/ Tj1c'oMA GUlV 9��0/ �oZi'-7446 AMERIN�/% <br /> OENENAICONTMGT(M MA2�WDRESS CIiY ZIP PNONE LICENSEI <br /> � �MECNANICALCONTR�GTOR IAMLADDRE55 GITY ZIP pHONE LILENSEI <br /> 1 <br /> �{) RUMBINOCONTMCTOR MAILADORESS CITY 21P PHONE LICENSE� <br /> / <br /> � CLASS OF WqiK <br /> � �� NEW O ADDITION ❑ ALTERATION O REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION - <br /> � <br /> TENN711MPROv[.:-'ITORMTER PEMODELONLY CONT�CTPERSON OPMONENO. ��� <br /> � .�/ � pe / �7 ^ /� � '�, <br /> CONTMCT PNICE OF WOFK: � O W E LL (Q G� � ��^("'( � <br /> � pEgCpleEWOqKANDSWAREFC0T110E NVOLVED <br /> j � GG vM� � <br /> � PROPOBEOUBEOFBUILDINO I H'eREBY CERTIF'! THAT I HAVE READ AND EXAMINED THIS <br /> � µ��(„ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ; IEOKDEBCRIPTIONOFPROPERiV�bHOWNBELOWORAITM:NFWRCOPIES) PROVISIONSOFLAWSANDORD�NANCESGOV'cHNINOTHISTYPEOf <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OFt <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VF: <br /> . ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR fHE � <br /> ' PERFORMANCE OF CO UCTION.THAT I AM AUTHORIZED BY THE <br /> . OWNER OF THIS F ER TO PERFORM THE WORK FOR WHICH <br /> APPLI TION I DE AND I PLY WITH THE STATE <br /> � � CONT ORS 1 7 W AN . WAC. - <br /> SIGNA GONTR � Z OATE <br /> ' <br /> 1 y <br /> � A ' <br /> �� PROIECTADUNE55 j�._� C IC�AN <br /> .- "IJ y�� �DWR.i� APPLIC�4fSC1TYBUSINE55LICENSEHO.ANDBUSINE55NAME <br /> L T+ <br /> PLUMBIN41 MECHANICAL <br /> � � NO. TYPE OF flXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> � �, �, WATER CLOSET(TO�LE� � A/C—A/HNDLG UNITS—H.P. � � <br /> � �,� , BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A,� � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � ; <br /> ' ��� �,"- - SHOWER � � CLOTHESDRVERS � � <br /> �� .t;;"` � KITCHEN SINK 6 DISP � VENTILATION FAN ; <br /> ^ DISHWASHER � RANGE HOOD � � <br /> �"'� - LAUNDRYTRAY ; WATERHEATER ' <br /> .��F;r�� CLOTHES WASHER i WOOD STOVE � � <br /> `.�+T�" UHINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> . � ORINKINO FOUNTAIN i FIREPLACE INSERT ; '- <br /> ' FLOOH DRAIN � - � HEAT PUMP � i <br /> ` . BACKFLOW PREVENTERS ; GAS PIPING ' <br /> �i ROOF DRAIN�RAINLEADERS � EXHAUST FAN —i— <br /> � � � SINK(SEFVICE—BAR,ETCJ ; ' <br /> i <br /> � � <br /> I � i <br /> � •. SUB TOTAL S i SUB TOTAL S ' <br /> PERMIT $ � PERMIT S � <br /> � TOTAL FEE $ ' TOTAL FEE $ � <br /> { FflONT SET�CK flEAq SETBRCK SIDE SETBACN PUN CHECN NOMBER FEE RELEIPlNO. <br /> S <br /> � usez LOT�pEA VACANTSITE FEES VALUATION FEE , <br /> � ��� ❑ YES ❑ NO BUILDING . i <br /> � 7YPEOiCONST.ALIOWTBLE iYPEOFCONSi.�CiUAL �PAwcY w.IXow[luM0uMn5 <br /> GRWP � I <br /> PLUMBING ' <br /> i <br /> � T <br /> � 6REOFBLD(i. • ND.OFSTONIE9 BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO , <br /> I . OGGUPANGYLOAD FIRF^'RNNLENSREQD HEIGHTLIMITATION OTHER j <br /> ❑ YES ❑ NO STA7E BUILOWG SURCHARGE � <br /> i REASONFORSPRINKLERS <br /> I � STATEENERQYSURCHARGE i <br /> i APPLIC�TONACC.BY PL�NSAPPROVEOBV CITYOFEVERETi PUBLICWORKS i <br /> � �1� TAl(COOE S 3105 TOTAL � <br /> � T'.'��FF.�' ':� .'ii��. i �• �.Y`�', .i4i� d _ .l.� � J:,:�1�. + �' 1 .F <br />