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fN Er�rprNn � <br />cm oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />� 1PPLICATION FO���:` <br />' CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COIVIBINATION <br />.�,Bl11LDING ❑ MECHANICAL <br />%��3,'�,Iv.� $d <br />AqLNITEC10flOE5�GNEH MMtApORE55 G��r n✓ <br />�✓a� Mouxa.�Ar�/P�et►itEc�� tvtoo ►�o�tE►�e aw.i.�vul�,�4 qem�, <br />GENER�LGON?^�G10N M�ILnODfiE55 C�LY ZIP <br />M �co�.1 lu�. �x�. 6oX 6�54 l,�l(�Nwoo� wF�• a8o3�O <br />���� . <br />g�l-7 buD <br />everetl <br />e <br />❑ PLUMBING ❑ SIGN <br />PHOKE <br />�21- 2m85 <br />v��or+e <br />E01-Z�,oO <br />PI�ONE LICENSE • <br />;'15- 894� Mi[qJ I- l5ew <br />PLUMBM6CONTfl�G10H M�Rn00AE5S Girv 21P PIICN(. IiCENSE• <br />CLASS OF WORN <br />� NEW ❑ ADDITION ❑ ALTEF7AilON ❑ REPAIR ❑ UEMOLITION ❑ WOODSTOVE/FRPL.INSER'( ❑ BUILDING RELOCATION <br />V�L W i10Y OF WOf1K IGOST OF M�TER�ALS PLUS IPOL�Pi <br />'s�0��'D�0 <br />DESCRi9E WONN <br />10.600 S•F 1�3�'i gi.ocl�- g�,pq. t,�� t�ooD PocF 'iFt�Sd6-S ��fll.�''U� P-c�oF�E.._ <br />.� <br />LO�� BLOGIL� <br />�-ZS 5.�, �/f <br />PLUMBING <br />NO. TYCE OF FIl(TURE OR <br />WATER GLOSET �TOILET) <br />BATFI7UB � <br />UVATORV (WASH BRSIN� <br />SHOWER <br />KITCHEN SINK d DISP. <br />DISHWASHER, <br />' UUNDRY Tfl11Y <br />CLOTHES WASHEH � <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN ' <br />BACKFLOW P:iEVENTEFS <br />HOOF DRAINS — RAINLEADERS <br />sMK iFFRVICE — BAR. FTC.1 <br />�PONTSEiB�LN '� <br />usezone <br />ttve ocf,pNs � <br />�w <br />SREOFBIDO. <br />�,.„,. <br />FOUN <br />SUETOTAL ' 3 <br />PEiiMii f <br />TOTALFEE f <br />RE�FSET6�CN SIOESE <br />�oT <br />� Z <br />VACANT SIiE <br />�YES ONO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIVED THIS AP• <br />PLICATION AND KNOW THE SAAIETO BETRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GQV�RNINGTHISTYPE <br />OF WORK WILL BE COMPLETEU INITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES �'OT FFlESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR IOCAL LAW REGULATING I:ONSTqUCTIOIJ <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF LONTRACTOR OR AUTNOlIIZED AGENT bATE <br />X-�1-�'hl,`� �'�a'�1 <br />NO <br />MECHANICAL <br />FEE NO. � TYPE OF WU <br />A/C — A/HNOIG UNITS — H.i <br />REFFIGEFlATION UNI �5 — H.I <br />BCIL[RS -- B.T.0 /H.P. <br />GAS FIREU A.C. UNITS — B.T. <br />FOHCED AIR SY3TEM5 — B.T <br />WALL MEA7EAS — 6.T.U. <br />UNI'f HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />VENTILATION FAN <br />iIANGE HOOO <br />WATEH HEATER <br />WOOOSTOVE ` <br />METAL FIREPLACE 8 CMIl.INI <br />FIflEPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />NO. OF �WELLING UNITS <br />%}' <br />2 <br />APPLIC�IION�CC.BY PLANSL'NECNEOBY �PPq.FONISSU�NLEBV <br />,�'w� ' � � -c . <br />�7�' f3�'� fZ,pv�/, � til�d,� <br />%�?.�/lGr'� �-�,� • <br />P�AN CMECKNUMBER <br />�7 � I �(nii <br />BUILD�NG <br />PLUMBING <br />MECHANICAL <br />M <br />M <br />SUB70TAL <br />PEHMIT <br />TO7ALFEE <br />IFE���6� <br />O7HER <br />STATE BUIL�ING SURCHARG <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />RECEIPT NO. <br />PflOf FRTY OWNEfiS ARE RE�PONSIBLE FOR DETERMINING ALL <br />PRCPERTY LINE LOCATIONSAND R'cLAThD EASEMENTS <br />B�L <br />