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IN ErnprMn <br />LITV OF <br />everett <br />BUILUING DEPARTMENT <br />259•8810 <br />APPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />everett <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OY/NER MAIL ApDRE55 CIIV ZIP PMONF —r3 � <br />��,�� �.`s�io2-- ��4 S�a F�� �,��II uiw�� �v-f c�ko �8�0� <br />AFCMIiECT tSiGHFji MAILADDRESS CITY IIV f nunur <br />%-� 'r e F- � <br />GENERALLONiRACTOR <br />PWMBiNG LOHfR4CIOR <br />�y <br />MAR appqE55 <br />/ <br />�! � �/ <br />CItV ZIP PIIONE <br />Cir/ 2�P MIONE <br />CI NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ DUILDING RELOC�TION <br />VALUr1T10N OF WORN �CJST OF 1.1Ai[ RIALS PLU$ Lr180R1 <br />��. %9k � 3. <br />OESCRil3E LVOFK <br />USE UF Ou1LDING <br />� <br />PROJECTA�ORESS <br />°� `.�Z 5 � <br />PLUMBING <br />WATER CLOSET �TOILET) <br />� BATHTUB <br />. LAVATORV�WASH BASIN� <br />SHOWER <br />� KITCHEN SINK d DISP <br />DISNWASHER <br />LAUN�R'/ TflAY <br />UF7�NAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF DRAINS — RAINLEAOE <br />SINK �SERVICE — BAR. ETC.� <br />FHpNTSEiBNCk <br />rvPE O�, ST <br />X <br />Si2E OF BL�G � <br />22 z <br />FI <br />OR ITEM <br />SUBTOTAL <br />PERM17 <br />TOTAL FEE <br />REAR SETBACN <br />OCLUPANCYGFOUP <br />R-� <br />PLANS CHEGKEO 8/ <br />��i <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP� <br />' PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />JIIriCOPIE51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />� � OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE• <br />. IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEFFORMANCE OF CONSTRUCTION. . <br />$IGNATUFE OF GONiFI :TpR pR qUTMORIZEO AGENi pATE <br />X � � $ <br />APPLILANTS LI1 V BUSiNE55 LiLE115E ND <br />FEE <br />SIOE SETBaCN <br />❑YES �O <br />/ <br />NO OF DWFLLIYG UNi75 <br />-�^' <br />MA% OC^C'LOAAD <br />/V IT <br />APPR FOR ISSIIANLE BV <br />L- - C. . <br />MECHANICAL <br />NO. TVPE OF EOUIPI <br />A/C — A/HNOLG UNITS — H.P. <br />REFRIGERATION UNITS — N.P. I <br />BOILERS — B.T.U./H.P. <br />GAS FIRED A.C. UNIT� — B.T.U. <br />POFCE� Alq SYSTEMS — B.T.U. <br />WALL HeATERS — 6.T.U. <br />UNIT HEATERS — B.T.0 <br />EVAPORP.TIVE GOOLERS <br />CLOTHES DRVEr75 <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEii <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIPEPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHE K NUMBER <br />�7 19 l� <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />FEE <br />SUBTOTAL <br />PERMIT f <br />TOTALFEE 3 <br />FEE RECEIPT NO. <br />I � � V <br />VALUATION FE <br />$ <br />OiHER <br />STATE BU�LD�NG SURCHARG <br />S7A7E ENERGY'_ "f; HARGE <br />PU6lIC WOPKS i` <br />TOTAL <br />PROPERN OWNERS ARE RESPONSIBLE FOF DETERMINING AlL <br />PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />