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_ ,�• <br /> , .PPLICATION FO:: �. ��«<n <br /> �M Ewrprnn CO N ST R U CT I O N O <br /> C�fY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> rl DEMOI_ITION f"1 COMo1NATION Til BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWHCfl MUL�DORE55 Lltt IIP PNONE <br /> l�1�- r��v� �a�Eer azvc Co � ,�ti Evr-Qt-rr 9S3o� z5z-�s�o <br /> ♦PCHilEG10N005iGNEH � MMI�D�RC55 GITY 21P PIIONE <br /> r MAIL��DRESS LIIY ZiP PIIONE ULEnSE• <br /> GENEHALCONIN�CION <br /> SF L� CITY ZIP PNONE � IICCN54• <br /> MEC���N�Gt GONLPaLIOq M�II�DDNE55 <br /> PLUMBiNOCONIFAGiOR M�ILAD�AESS ��TY IIP MIONE 16EN5E• II <br /> V I <br /> CL�SSOf�WORN <br />—[I] NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT BUILDING RELOCATION <br /> V�IU�T ON OI wONN�COST OF MA1LRUl5 PWS UBONI <br /> �.�D O D � � <br /> o�scnm�ww+rc / / / p J / <br /> Q .�� <br /> use or UIIDING � � 1 HEREBY CERTIFY THAT I HAVE flEAD AND E%AMINED THIS AP• <br /> �� Q V PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br /> �e nesenirnoN veavenry$IOwNO[LOWOH�IT�LNfOtIPCOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ��t�� �� OF WOflK WILL BE COMPLETED WITH WIIETHEq SPECIFIED HERE• <br /> iory'�uiocr.���F IN OR NOT.THE GRANTING OF A PERMIT DOES 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. �j <br /> SIGNATU(7EOFLONiR�CTOROR�UTNONIZEOAGENi DA1E �7/'/� <br /> / <br /> / <br /> AP �NTS ITYBUSWE LICENSENO. <br /> PPOJELIAO�RE55 . <br /> aao5 (!�- <br /> MECHIINICAL <br /> PLUMBIN6 <br /> NO. TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> ATER CLOSET(TOILEn AIH COND.UNITS—M.P.EA. <br /> PEF IGERATION UNITS—H.P.EA. <br /> BA MTUB <br /> �qV ORYIMGSNBASIW BOIL RS—NP.EA. <br /> OAS EO AC.UNITS—TONN�GE EA. <br /> SHOW <br /> KITCMEN NK 8 DISP. FORC AIR SYSTEMS—B.T.U. M EA. <br /> WALL H TERS—B.T.U. M <br /> DISMWASME <br /> LAUNDRVTRAV UNITf1EAT —B.LU. M <br /> CLOTIIES WASHER EVAPOR/71VE C LERS <br /> WATEPIIEATER CLOiMES DRYERS <br /> URINAL VENTILATION FAN <br /> DRII.K�NG FOUNTAIN PANGE NOOD <br /> AIR MANOLING UNIT— C.F. <br /> FIOOR L?A�'1 STOVE — <br /> VACUUM BREAKERS <br /> ROOF ORRINS—RAINLEADERS METAL FIREPUCE 8 LHIMNEY — <br /> SINN ISEPVICE—BAR.ETC. WOODSTOVE/FIREPLACE MSERT <br /> SUBTOT�L SUBTOTAL <br /> PERMIT f PERMIT � — <br /> TOTALFEE i TOTALFEE � � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PUN CNECM fEE ' <br /> /PONIS[IB�CN �EARSETBAGN SIDESETBACN pIANGNECNNUMBER `EE L`3 p[LEIPfNO <br /> io � s sG���c�4� 3a= �Pso�— <br /> US[20NE LOi�R[� V�C�NTSITE FEEB V�WATION FEE <br /> �^ �" I I i2� �F OYES �O <br /> iYP[Off01�5i OCC�PANLYGPOIIP NO.OFDWEILINGUNlT9 <br /> N (1�1. � � euiioiNo s SL!',.,p.� SZ� St7 <br /> size oLLui nc ra or sroniEs M�x.oee �oeo <br /> f'/� /p �� PLUMOINQ __ <br /> � J <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES NO OTnER <br /> PENALTY _ <br /> •1•���GIIONnCCOr PL�NSGHECNEOBY �PPH.FORISSU�NCEBY �O rn <br /> TOTAL •��_J <br /> JfJ�' L -G <br />