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,�.E,,,,�,� 'S�''•�PP LI CATI O N FO F�Yi <br /> CONSTRUCTION `"`.`" <br /> atr or <br /> everett P�RMIT � e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑SIG►� <br /> OWHEF M�II rDDPE53 CITY IIP MOHE <br /> �zii,a-�- �,��-�,r,�tzL;cE' �'x�n�5 /�l /�icxtA.,l.c.�1-c� �a,� � � <br /> ARGNtECTOHDE50MEH M�IL�DDRE59 GITY IP PNONC <br /> OENEReI CONiR�C10R MeIL�DORES$ Clh ZiP PNONE UCENSE• <br /> MECMANILeLLONTR�CiOq M�IL�OORE55 CItV 21P PNONE LICENSE� <br /> PWMBiNOGONiH�pfOF M�IL�OORE55 . CIiV ZIG PIIONE UCENSE• <br /> N���-C�f15 $�i �J�/' ,1(0�5 �= /?1C1-uricv/ ia, �i'��- N�7u�GC 3�/ll P <br /> CLASSOF WOAK �� <br /> ❑ NEW ❑ ADDITION L�'C ALTERATION ❑ REPAIR ❑ D[MOLITION ❑ WOODSiOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> W1lU�ilON OF Wpqe�COSi Of M�IERI�lS PLUS 1�80N1 <br /> DESCiVBE WORN <br /> 0-,0 �Q.,uZf'Y�c�_- <br /> i V6E OF B IL�IHG <br /> ���l,n`�C � I HEREBV CERiIFY TNqT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BETRUE AND CORRECT.ALL <br /> ICU�L�ESCRiPTipNO�PqOPEHTYISNOWNBELOWOR�iT�CNfOURC0�1[51 ppOVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE- <br /> �oi_e�oc�_ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT FRESUME TO <br /> ' GIVE AUTHORItV TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. � . <br /> SIGN�TUfiE OF CONTPACiOR OR Al1THOR12ED AG@NT DRTG <br /> PROJEGT�ODAE59 / �FP�ICeNiSCITYBW�NE59liLENS� � �� <br /> j PLUMOING MECMANICAL <br /> NO. TYPE OF Ftl(TURE OR ITEM FEE NO. T'PE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� iVC—MHNDLO UNITS—N P. <br /> � BATHTUB REFRIGERATION UNITS—MP.EA. I <br /> � LAVATONV�WASHB�SIN� BOILEFS—B.T.U./HP. <br /> � I <br /> SMOWER GAS FIREO�.C.UNITS—B.T.U. <br /> KITCHEN SINK 6 DISP. J FORCE�AIR SYSTEMS—B.T.U.�IS EA. I <br /> �� DISNW�SMEfl WALIHEATEHS—B.TU. M I <br /> � UUNDRV TR�V UNIT HEATERS—B.T.U. M <br /> � I <br /> CLOTMES WIISHER EVIIPOR�TIVE COOLERS <br /> URINAI ' • GLOTNESORYERS II <br /> 'y ORINNINGFQUNT�IN VENTILATIONFAN <br /> v ' FLOOR DNAIN ' R.�NGE HOOD �I <br /> � BIICKFLOW PREVENTERS WATFR HEATER . <br /> f ROOFDR�INS—RAINLEADERS WOODSTOVE � <br />� � SINN�SERVICE—BAR.EiC� MEfAL FIREPLACE 8 CHIMNEV <br /> 3 FIREVLACEINSERT i <br /> HEAiPUMP <br /> j GAS PIPINO . <br /> 1 <br /> EXHAUSTFAN �. <br />� SUlTOTAL 3 SUlTOTAL � I <br /> ' PERMIT i OERMIT � <br />� � TOT11L FEE f TOTAL FEE <br />' ' rRUNi SETBeCK nEeR SEtB�GK Si�E SETBecK � �AN CNECK NUMBER FEE RECEIPT NO. <br />( 1/SEZONE LOi�NE� - <br /> `.'AC�NT SIiE FEES VALUATION FEE <br />' � OYES ONO . <br /> ttPEOfLON51. p��UPAH�YGHOUP NO.OFpWELLINOUNli9 BUILDING S <br />� <br /> PLUMBIN6 <br />� SRE Cf BLDO NOAF 9iORiES M�%.00C.IOAD <br />� MECHANICAL <br /> OTHER <br /> f�RE SPRINKIERS REOUIRED O YES O NO STA7E BUILDING SURCHARGE <br />� <br />� STATEENERGYSURCHARGE <br /> ,�FFUGqIpry�CC BV PL�NSCNECKEDBY �PPR.fOR155U�NGEBY <br /> � PUBLIC WORKS <br />� — <br /> TOTAL <br /> 1 <br /> r <br />• PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMINING ALl <br /> PROPERT'LINE LOCATION9 AN�REUITED EASEMENTS. <br />� <br />