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� :��., <br /> ,ME,.ro�.� :a��'PLICATION �01:�" <br /> CONSTRUCTION `"`�'�°" <br /> urr os <br /> everett PERMIT � <br /> BUILDING DEPARTMENT ' <br /> 259-88�0 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> OWHCA M�4�D[tR155 LITY ZIP PNONE <br /> hmAc4�Yc,c.� cl('.CQ , I�1�� Q)t�Cte��c��ct. �� "� P1L oa5s-d599 � <br /> �RCHIiCCIOBOl51C,NER M�IL�ODRFSS �i =�p <br /> GlH(RAl CONIH�CTOR M�I��D�RESS CIiV ZIP PNONE ����ryy�� <br /> MLLNANiULCC1ITR�CiOq M�IL�DORE65 G11V 21F PMONE tI�ENSE• <br /> PLUMBNbCON1R�ACTOR/� MMt�DDRESS ����y��N� <br /> _��.�/lfY�- 1��111� Lo. ►�a5 �- ma���.. C'tt 2'P PNOHE LICEHSE• ,, f <br /> �u<< ,L1", n.�, T��A. , <br /> CL�55Of WORM <br /> ❑ NEW ❑ ADDITION �ALTERATION ❑ REPAIp ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATIOI� <br /> Wl WiION Oi WORn�COSf O�H1f(RIAL^u PWS L�BORI <br /> DESCR�BE WORn <br /> �ns#Pr�I �vn.Lt. �,1�.(�tx;�',�. . <br /> use or ew�oir�c ,�M � p � n, � q ^ � � ' <br /> C��I ��7LK/LC� . A{.G�-II�JLVd�J � ��ER[BY CERTIFV THAT I HAVE READ AND EriAMINED THIS AP•, <br /> PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL <br /> LEO�LDESCP�PTIONOfPROP[RiYISNGWNBELOWOF�ti�L��fOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE� <br /> ior_a�oc�_ov OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED NERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTIiOqITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> ANY OTNFR STA7E OR LOCAL LAW REGUTATING CONSTRUCTION <br /> OR THE PERFOHMANCE OF CONSTAUCTION. . , <br /> SI6N�lURE OP CONTF�CTOR OR AUiHOR12ED AGENT fUIE <br /> X � <br /> PRGEGT�DOPE55 �� /� APFLILAHTS CrtY BVSIN[SS UG[NSE NO �� <br /> f ' " �� <br /> ►LUMSING MECHANICAL <br /> NO. TYPE Oi Fl1(TURE OR ITEM FEE NO. TYPE OF EOU�PMENT FEE <br /> WATER CLOS[T�TOILET) qiC—A�NNOLG UNITS—H P <br /> BATHTUB qEFRIGERATION UNITS—N P.EA. <br /> UWTOAY�W�SM BASIN� BOILEPS—B.T U./N P. <br /> SHOWiF GPS FIRED�C.UNITS—B.T.V. <br /> KITCNEN 5'NK i OISP. fORCED AIR SYSTEMS—B T.U. M EA. <br /> DISHW�SMEH WpLLHEATERS—BSL. M <br /> UUNDNV TRAV � UNIT NEATERS—B T U 75 M <br /> GLOTHES W�SNER EVAPORAI"IVE COOLEi15 <br /> URIN�L CLOTHESDRYERS <br /> � DRINKING FOUNTAIN VENTILATION FAN <br />. FIOON DRAIN qr1NGE MO00 <br /> BACKFLOW PREVENTERS WA7ERVIEATER <br /> ROOF ORAINS—RAINLEAOERS WOOD STOVE <br /> SIKK�SEHVICE—BAR.ETC� MEfAL FIREPLACE 6 CHIMNEY <br /> FIREPIACE INSERT <br /> HEAT Pl1MP <br /> � GAS PIPING <br /> E%NAUSTFAN <br /> BUSTOTAL f SUB TOTAI — <br /> PEPMIT f PERMIT <br /> TOTALFEE f TOTALFEE � <br /> IRONTSEIB�CM aE�q5ET0�CK Si�ESE7BeCR FLANCHECKNUMBER FEE RECEIPTNO. <br /> US[jONE LOTARE� <br /> V�C�NTSiTE FEES VALUATION FEE <br /> OYES ONO <br /> T�'PEOFCONST. OCCUPANCYGHOUP NO.OfOWEILINpUN1}5 OUILDING S <br /> PLUMBING <br /> SilE Of 91D0 NO OF S10NIE9 M�%.00G.LOAU <br /> MECMANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑VES O NO STATE BUILDING SUHCMARGE <br /> STATEENERGVSURCHARGE <br /> �PP�IGIION/.LC Bv PL�NSCHECNEUBY �VPR.fOHISSWNCEBY � <br /> PUBLIC WORKS <br /> T0T4L <br /> PROPEPTY OWNERS ARE RESPONSIDIE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />