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, .PPLICATION FO..� ���,�� <br /> tMEwqn�n - CONSTRUCTION � e : <br /> CIiY OF <br /> everett PE RM IT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK• PLEASE PRINT <br /> 259•8810 <br /> ❑DEMOIITION ❑COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> OWNER M��l��ORE54 C17Y 21P PNONE I <br /> a �2 CoU3 � 9 sz-2�5 <br /> MAIL��DR[55 C�iY ZIP PNONE I <br /> �RCNITECtO DlS�ONEN I <br /> ` - S CILY IIP PHONE LIGENSE• ' <br /> GENER�LGONiP�GtOR M�II�ODBE55 <br /> w v tiu,ul <br /> L�u-rd►J �n1s�r Cs� 135t�5 S�i rtE f�iu ��,TM 9K2y0 �38E L��u�ros►��{�G-, <br /> MECN�NiGLLONiR�GTOB M�II�D�RE55 ; <br /> �i <br /> PLUMBINGGONTNAGIOH MAIL�DOAE55 CITY 21P VIIONE IICENSE• i <br /> � � <br /> I�fJ I <br /> CUSS Oi WORK �' <br /> ❑ NEW ❑ ADDITION �ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ Bi11LDING RELOCATION <br /> V�lU�T10N OF WOHK�COST 0�M�TERUL$�W S L�BORI i, <br /> I <br /> DFSCR�eE WOPN �q/ <br /> �rR I ��1 � r <br /> uscuv ewiqu+(: / I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br /> '� PLICATION AND KNOW THE SAME TO BE TRUE ANUCORRECT.ALL <br /> icce 0 SCAIP110NO�PAOPEPTYISNOWHBEIOWOR�ITALNFOURGOPI[51 PpOVI510N50FLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE• <br /> io�—e�oc�—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHERSTATEOR,LOCALIAWREGULATINGCONSTFUCTION <br /> � OR THE PERFORMl�NCE OF CONSTRUCTION. . <br /> SIGNATOPEOFGOJI4P�ET(]ROR iNORIZE�RGENT DnTE <br /> A <br /> �PPLIf.�NiS USINESSLiLENSE I <br /> VROJELT�DOHE55 <br /> 2812 Ccx.a QuE. F.�.���i � �w� <br /> PLUMSIN(i MECHANICAL i <br /> NO. h'PE OF FIIITURE OR ITEM FEE NO. TYPE OF EOUIPMENT FE! <br /> 2 WAiEN GLOSET�TOILET� ' MC-A/MNOLG UNITS-N P. �: <br /> BATMTUB REFRIGERATION UNITS-N P.EA. � <br /> LAVATORY�WASM81151N1 � '- BOILEPS-B.TL/MP. (' <br /> i <br /> SHOWER GAS FIRED A C.UNITS-B.T.U. � <br /> I(ITCHEN SINK 8 DISP. FORCEO AIR SVSTEMS-B T U. M EA. ; <br /> �ISHWASMEH WALLMEATEH$-B.T.U. M <br /> i <br /> UUNDRY TR�Y UNIT MEATEPS-B.T.U. M I <br /> CLOTMES WASMER EVAPORAiIVE COOLERS �, <br /> (.LOTNES DRYERS � <br /> URINAL t <br /> DRINKING FOUNTAIN <br /> VENTILATION FAN <br /> fLOORDNAIN � ' PANGEHOO� <br /> BACKPLOW PREVENTERS WATER HEATER i. <br /> ROOF DRAINS-F1A�NLEADERS WOOD STOVE �' <br /> SINK�SERVILE-BAR.ETC) �- � '- METALFIREPLACEBCHIMNEV , <br /> FIPEPIACE INSERT . <br /> MEATPUMP � <br /> GAS PIPIN(i � <br /> EXHAl15T FAN <br /> 6USTOTIIL 3 ,=(' (''! SUOTOTAL P <br /> P[pMIT � <br /> PERMIT f (�` r�'�' ; <br /> TOTALFEE f - 'O' Y T��� TOTALFEE { <br /> ' PLAN CMECK NUMBER FEE RECEIPT NO. � <br /> �RONiSETBAGK RE�R SETB�LR Si0E5EiB�GN � <br /> t <br /> usezoNt �Oi�PE� y�CANTSIfE FEES VALUATION �E <br /> pYES ONO - 5 � <br /> BUIIOING <br /> ttPEOFCON51 OCCOPANGYGROIIP NOOFDWELLINOUNITS ` <br /> . PLUMBIN6 ( <br /> SiZE OP BLDO NO OF STORIES MAM OGG lOAO MECHANICAL ' <br /> i <br /> � � <br /> OTMER � <br /> FIRE SPRINKLERS REOUIRED ❑�ES ❑NO STATE BUILOING SURCHARGE � <br /> I <br /> STATEENERGYSUHCHnRGE ' <br /> PVPLiUT10N�CG Bv PL�NSL'NECNEDBY ��PA.fORI55U�NGEBY pUBLICWURKS I <br /> � ! <br /> TOTAL <br /> � I'i <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DEfERMININO ALL <br /> PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br /> ,` <br />