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�PPLICATION FO��:� <br />,°.E°.,°,"° CONSTRUCTION <br />an oc <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ G.,MBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING <br />OWNER MNILAOORE55 Gnr ZiY P�WNE <br />vY�is �rnrar�Y 360� �3zND s�_ ��_�vU� qg�6 ��--43� <br />ABLHiTECTORDESiGNER MRILADORE55 Cltt 21P PIIONE <br />everen �' <br />" ;:. <br />;''. <br />❑ SIGN <br />GENEB�L LOMflRCIOR MAII PO�RE55 LItV 21P PIIONE LICENSE • <br />�M5 ��- �. 10Z11 la,�. 6`b�- Su�TP �-17d kEi�Moi�� i�`�o�Z 0?i3-oz41 �7.t5�0.J'�1Sok5 <br />MECII�NIGALCONIRRCiOq MAIL�OORESS CitY ZIP p110NE LICENSE• <br />P� d�F� NE.tn� 19103 hlE 6�� 6��, L � IIEAMa.J� �`IBoSL 881 ^79� KUNE-AA-�z93kP <br />PLUMBiNG CONTMCiOfl MAIL ROORE55 CIIY 2�V PMON� LiCENSE � <br />CLASSOF WOHNtc� <br />❑ NEW lq ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOIITION ❑ WOODSTOVE/FRPL.INSERT ❑ Bl11LDING RELOCATION <br />VAIUAT10NUFWOPKICOSiOFlAAiEPIAL$PLUSLROORI ' <br />0 <br />� � Z � ��i 1_ <br />,ae��a�- <br />I�T'7�IL <br />iece� oescni <br />LOi_BLOC�_ <br />PPOJECTAOONE55 3,C, P�� <br />?"iOs �Vf.f¢�EEhS 1S/� <br />PLUMBING <br />Y/ATEfl CLOSET (T011l <br />BATHTUB <br />LAVATORY�WASH BA: <br />SHOwER <br />KITCHEN SINK 6 DISP. <br />oei ow on <br />Y, 5Ui1� <br />`18203 <br />�� <br />I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND COARECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEA SPECIFIED HERE- <br />IN OR NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OF LCCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF CONiPACTGR OR AUTNnqIZED AGENT fIATE <br />X <br />�USINESS LiCENSE NO <br />MECHANICAL <br />OR ITEM FEE NO. TYPE OF EOUIPMENT <br />A/C — A/HN�LG UNIT S— HP. <br />�' IREFRIGERATIONUNITS—HP.EA. <br />T— �I�901LER5 — B.T.UJH P. <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />6ACNFLOW PPEVENTERS <br />ROOF DFAINS — RAINLEA�ERS <br />SINK �SERVICE — BAR. ETC.) <br />SUBTOTAI <br />PERMIT <br />TOTAL FEE <br />iRONISEiB�CN IpE�R SETBACK �SIDE <br />USE20NE <br />SKE OF BIOG <br />UY <br />LOi AHEA I VqCANT SITL <br />OYES ONO <br />NO OF Si0R1E5 <br />GAS FIRED A.C. UNITS — B T,U. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />11N1T HEATERS — B.T.U. M <br />EVAPORATIVECOOLERS <br />CLOTHESORYERS <br />VENTILATION FAN <br />flANGEHOOD ' <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE d CNIMNEY <br />FIPEPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />sue Ta <br />PERMIT <br />TOTALI <br />PLAN CMECH NUMBER IFEE <br />BUILDING <br />NO.OFOWELLWG UNIiS <br />PLUMBING <br />ueR OCC. IOnD MECHANICAL <br />OY <br />VALUATION <br />$ <br />FEE <br />RECEIPT NO. <br />O7HER <br />STATE BUILDING SUFCHARGE <br />STATE ENEPGY Sl1HCHARGE <br />PU�LIC wORKS <br />TOTAL � <br />PFiOPERT/ OWNEf1SARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />i <br />