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.^ <br /> S'�PPLICATION FOk�'' <br /> . pE�'°'"" CONS RMI TION �`e <br /> everett PE T <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNE `��MI�OOPES CITv IIP FHON[ <br />—���, n��Tc� r+��`� �o�%�-� 1J�'ec� C�r Sl�4+vwo�j `11�'.�2`��1 Cs",�-k)oFr <br /> •PCNIfEGiOBDkS�ONEf1 —�O�AE55 CifY ZiC P��ONE <br /> GENCR�t GONIMCIOR M�IL��ORE55 J ��n' IIP PONE LILENSL• <br />_ Qw,�xf` Sxlv►�� /XS,�� Sou �..,� ��'��a ���. <br /> MECN�NIG.LCOMR�LiOfl M�II.MORL54 CIfV ZIP VIIONE lIC[NSE• <br /> VLUMOINOCONIR�GiOf1 M�II ApOA[55 CIIY ZIP PIIONE UCENS[• <br /> CL�550�WDPN <br /> ❑ NEW ❑ AD�ITION ❑ ALTGiiATION ❑ REPAIR ❑ DEMOLIiION �-WOODSTOVE/fRPL.INSERT ❑ [1U401Na f1flOC4tIDN <br /> WLU�IIONO�WO�MICO510�M�1EFUl$1'W9UBORI <br /> OESCRIB[WOPN �r�aC� �1_O�� � <br /> ^ //�7S U- �� <br /> —UL�lx�6 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> C � 't,,._ PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEO�LDESGNIPI�ONO�nqpPERtt�S�iOWNOELOWOR�1tA�ni0U11GOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMFLETED WITH WHETHER SPECIFIED HERE- <br /> �oi—eioc�—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> , GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANV OTHEq STATt OR LOCAL LAW REGULATINC CONSTRUCTiON <br /> OR THE PEPFORMANCC- OF CONSTRUCTION. . <br /> SIGNs1URE OF CONTRPCTOR OR 4UiNOAIZEp q�ENT 1141E <br /> PROJEC��ORE55 APPLICAN SGIIYBUSINE99ltCEN5EN0 ( /�� <br /> � � �p l <br /> PLUMEIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OH ITEM FEE NO. TIPE OF EOUIPMENi FEE <br /> WATER CLOSET(TOILETI A/C—AMNOLC UNITS—NP. <br /> BATNTUB REFNI6ER�TION UNITS—H P.FA. <br /> UVIITORY�W�SH B�SIN1 BOIIERS—B.T.0 iH P. <br /> SMON'ER GAS FIRED A.C.UNITS—B.T.U. <br /> NITCMEN SINK 6 OISP. FORCEO AIR SVSTEMS—B.T.U. M EA. <br /> ' DISNWASMER WALLMEATERS—B.T.U. M <br /> UUNDRYTR�Y UNITHEATERS—B.T.U. M <br />� CLOTHESWASMER E`IAPONATIVECOOLEtiS <br /> UFIN�L CLOiMESDRYERS <br />� DH�NNING FOUNTAIN VENTIUTION FAN <br />'. FLOOR ORAIN RANGE MOOD <br /> B�CKFLOW PREVEN7ER5 WATER HEATER <br /> ROOF ORAINS—RAINlEA0ER5 WOOD STOVE � <br />� SINK�SERVICE—BAR,ETC) METAL FIREPUCE S CHIMNEY <br />' FIREPLACEINSERT <br /> HEATPUMP <br /> O�5 PIPING � <br />� EXMAUSTFAN <br />� SUSTOT�L f EUlTOTAL _ <br /> i PERMIT ! IKHMIT <br /> TOTALFEE f TOTALFEE <br /> iRON1$EfB�Lk RE�RSCIB�CM 5mE5Etancrc PL/+NCNECKNUMBER FEE RECEIPTNO. <br /> usemNe �or�neA VACANiSrtE FEES VALUATION FEE <br /> OVES OND <br /> fVPEOF�p49t. OCGUPANCYGRO°P NOAFDWEllIN0UN173 BUIL�ING S <br /> PLUMUING <br /> SKE 0�BL00 NO Oi StOP1E9 M�K OCC IOAD MECHANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑VES ❑ NO STATE BUILDING SURCIIARGE <br /> STATEENERGYSURCHARGE <br /> •VPUG110NA�C B� PUNSI'NECNEDBY APPRiORISSWNCEB� <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTY OWNERS ARE RESPONSIOLE FOR DETEi7MININO ALL <br /> PROPERTV LINE LOCATIONS AND RELATED EASEMENTS. <br />