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-� <br /> �PPLICATION FOF.=' <br /> IMEqrpn�n CONSTRUCTION ' �� . `°e <br /> an os . • <br /> everett PERM IT <br /> BUILDING DFPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK- pLEASE PRINT <br /> ❑ DEMOLITION ❑ C06ABINATION ❑ BUILDING Gl MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNEF � M�IL�DORESS �J�'1/' GI�I' 21P � , )PNON[ �� <br /> l! // <br /> ` �ii�iP a_! �.e�.c�� � .�1.r..,svc.I Av �i i i q$,L � <br /> ARCnRELTONDE5iO11ER MMLApDRES CIIY 21P PMONE <br /> GENEH�LCONiRAGIOR MMLAOUREL'3 CIIY 21P PNONE LIGENSE• <br /> � �� �✓��� <br /> MEGN�NIULCONfPApOq M�R�DORE55 Cltt � 21P PIIONE UGENSE• <br /> PWMtlINGCONiR\pOB MAIL�DDRE55 CITY ZIP pIIONE 4CENSE• <br /> C1�55 Lf WORK — <br /> ❑ NEW ❑ AODITION ❑ ALTERATION� HEPAIR ❑ f1EMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUII.DINa RELCCATION <br /> 1 VIWIQ��WO:ItiCO��OFMQENUL5PW5L�BOR1 <br /> T S U� <br /> DESCNieF WORK �i <br /> �� � � � . . . . ... <br /> USE OFlUIlDiNO <br /> '1 � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS AP• <br /> PL ICATION AND KNO W THE SAM E TO BE TRUE AN D CORRECT.ALL <br /> tEO�l0E5GNi��IONOF HOPEHttISNOWNtlElOW011�ITAGHFOURCOP1E51 pROVISIONSOFLAWSANUORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BECOMPLE'ED WITH WHETHEF SPECIFIED HERE• <br /> io�_e�oc�—or IN OR NOT.THE GRANTING OF A PEAMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNATURE OF CONTR�CTOR OR AUTHORIZEO ACENT DATE <br /> PROJECT�UORE55 ^)��� ���NTSCIfVBU5ME53U NS NO � <br /> V <br /> PLUMSINQ MECHANICAL <br /> NO. l YPE Of flXTUNE OR ITEM FEE NO. 7�/PE OF EOUIPMENT FE! <br /> WIITEP CLOSET�TOLLET) NC—A/MNOlO UNITS—H.P. <br /> BAYNTUP REFRIGERIITION UNITS—H.P.EA. <br /> UVATORV IWASH BASINI BOIlERS—B.T.U.MP. <br /> ���R OAS FIRED A�C.UN�TS—B.T.U. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISMW�SMER WAILMEATER3—B.T.U. M <br /> UUNDRVTRAV UNITHEATERS—B,T.U. M <br /> CLO�lIES WASMER EyAPoPATVE COOLERS <br /> ��N�� CLOTHES DRVERS <br /> ORINNING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN � RANGE NOOO <br /> BACNFLOW PREVENTERS WATER MEATER <br /> ROOF DRAINS—R�INLE/:DERS WO00 STOVE <br /> SINK(SERVICE—BAR,ETQ) METAL FIREPLACE 8 CHIMNEV <br /> FIREPLACE INSERT � <br /> HEATPUMP <br /> OAS PIPINO <br /> E%MAUSTFAN <br /> SUBTOTAL f ' gUSTOTAI ' <br /> ►ERMIT f r(RMIT <br /> TOTALFE! f TOT�LFEE <br /> 1 RONI SETB�CN PE�N SETB�CN SiDE SE70�CK �.AN CMECK NUMBER FEE RECEIPT NO. <br /> usetoNc LOfARE� WCANTSIiE . FEES VAWATION FEE <br /> m¢s oNo ' <br /> TYVFOfCONSi pCGUPANGYGBDUP NO.OFOWELLIN6UNIfS BUILDING S �' <br /> PLUMBING <br /> 512E OF BL00. NO OF SiOPlE9 M�X OCC,lOAD <br /> MECHANICAI <br /> O7HER <br /> FIRE�FRINK�ERS REOUIRED ❑YES ❑NO _ eTATE BUILDIN65UHCHAFGE '-j l <br /> � <br /> STATEENERGYSURCHAHGE <br /> �VPIIC��ION�CCB� PL�NSCHEGNEDBY �FPN.FORISSWNCEBY <br /> � PUBLtC WORKS <br /> TOTAL '� <br /> PROPERN OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PPONERN LINE LOCATIONS AND RELHTED EASEMENTS. <br />