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d`•'t: _'r_'1. <br /> IY`�'PLICATION FO �1:'�� , everetl <br /> '"'E"'°'"" CONSTRIiCTION � O <br /> LITY OF <br /> everett PE RM IT <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINA710N ❑ BUILDING ❑ MECHANICAL ❑ PLUM8ING �SIGN <br /> OWHEH i MML�O�R35 CITY 21P PHONE <br /> t'}-� RoL�iXC �T�Qe. C'o Ss3'o �,,;.. rJc-� ��$d cJ�+D _ 763— 93t3 <br /> A9CHIiECTONDE510NEN MeIlA00REo5 Cltt ZiV PMONE <br /> GlNERAIGONiHnG�OA M�IL4DUfIC55 CIfY LIN PI�ONE tICENSE• <br /> ,p���m������,�,a s,�� c�, sxas so. ,a-d,s�s �ec�,�. ��-_ 9�yo9 Y�.�33aa �dc;�-i�oa� <br /> MELNANIGAICONiNA�TOq MnRA00RE55 G�1Y 2iP P��ONE LICENSE� <br /> VL'JMBINGGONTp�GTOR MqLApORE55 GIIY ZIP PIIONE LICENSEi <br /> G1�55 OF WORN <br /> � NEW ❑ ADDITION ❑ ALTFRATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEF7T ❑ BUIIDING RELOCATION <br /> V�LU,y��ONOFWORN�COSIOFMALEHIRl5PW5lRBOP1 � <br /> �A'a'�GO 00 <br /> D�ES NI9E WORN � <br /> � �J � �S l' (�A-�-F-.$� !rr nJ 6 n/ [3�G'- fid-L'/lf' <br /> USEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> TiR� 5�rf�S PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.PLL <br /> LEG�LDESCRiPT10NOFPROPERiY1SNOWNBELOWORRT�lACHFDUaCOP�E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE• <br /> �o�—oioc�_oF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS /JF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNPTURE OF CON7RACTCR OP AUTNORIZED RGENT D4TE <br /> �_ �.� �/a3/�� <br /> PROJECT AODRESS A�PLI.ANTS CILY BUSINESS IiCENSE HO <br /> S3o �J Ol97/S <br /> PLUMBING ' MECHANICAL <br /> ryp. TYPE OF FI%TUNE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATFITUB � REFqIGERATION UNITS—H.P.EA. <br /> UVATORY�WASH BASIN) BOILERS—B.T.U./H.P. <br /> SHOWER GAS FIRED A.C.UNITS—B.T.U. � <br /> KITCNEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> � DISMWASMER WALL HEATERS—B T.U. M <br /> � LAUNORV TRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WIISHER EVAPORATIVE COOLERS <br /> URtNAL CLOTHESORYEPS <br /> DRINKING FOUNTAIN �ENTILATION FAN <br /> FLOOR DRAIN ' , RANGE HOOD <br /> BACKFLOW PREVENTERS WATER IIEATER <br /> RDOFDRAINS—RRINIEADERS N�OODSTOVE � <br /> SINK�SERVICE—BAR.ETC.) METAL FIREPLACE 8 CHIMNEY <br /> FIREPIACEIN5ER7 <br /> HEATPUMP <br /> GAS PIPING <br /> i E%HAVSTFAN <br /> SUlTOTAL f SUBTOTAL ' <br /> PERMIT f PERMIT <br /> TOTALFEE S TOTALFEE —'�� <br /> iRUNTSEi8l1LN RE�RSETB�CK 90ESETB�CN PIANCMECKNUMBER FEE RECEIPTNO. <br /> � ' r <br /> use zo LOT AREA. VAC�NT SITE FEES VALUATION FEE <br /> i Z - oves allo <br /> BUILD�N6 5 <br /> iYPEOFCONST. OCGUP�NGYf.FOUP NO.OFDWELLINOUNITS <br /> PLUMBING <br /> SREOFBLPO. NO.OFSTORIES MR%.00C.IO�D MECHANICAL � <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED. �VES ❑ NO � STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> •VPL�C�LIOHALCBY PLANSCMECNEDBY �VVP.FO�CFBY pUBLICWORKS <br /> � TOTAL <br /> PROPERTYOWNEFS ARE flESPONSIBLE FOR DETERMINING ALL <br /> PROPERN LI NE LOCATIONS ANU RELATED EASEMENTS. <br />