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�;-+PPLICATION FOr1' ���,�„ <br /> '".E"'°'»" CONSTRUCTION � <br /> �,ry oF <br /> everett PERMIT <br /> BUILDING DEPAR7MENT TO BE COMPLETED IN INK- PLERSE PRINT <br /> 259•8745 <br /> ❑ DEMOLITION ❑ COMBINATION ,�BUILDING ❑ MECHANICAI ❑ PLUMBING ❑ SIGPi <br /> MAIL�ODRE59 CItV 21P PIIONE <br /> cwr�en • �� d���y/t �EGD'��L`TT/ic�/J �/c�T_O% .3�/7' �1C�Uu <br /> B���,SS•c�i/�TF1 ljdi4Ui.c/l, � CItY 21P PI�ONE <br /> •RCNIIECfOR0E510NER MMlA00RE:3 <br /> .tl��/- DoUG!-i1s /�!c'Lb�h'�J.�';' ,P�G�.s�/v�, uJil � <br /> dEN.C/P�ICONtR�CION / MRILp�CrlE55 Q / /a�rv na ��7r����o I! 4CENSC. <br /> /]t����w�M1�� LO.tJTQ�C/'2�A�S ��i �d�li C`� /���i,(fL� �CZ� G(��rLL-n /�vCJ���/6t? <br /> MECIIAN�ULGONIA�CtOfl MAl1�001iE55 CIIY ZIP PIICNE LCC SE <br /> PLUMB�NOCONIfUGfOR MULAODPESS CIiY ZIY PI�ONF IICCNS[� <br /> C�U/S50!WORN <br /> y� NEW ❑ ADDITION ❑ ALTEfiATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING F7ELOCATION <br /> VeLU��ION OF W011N�GOSL OF M�I[I�I�LS PLUS LRBOBI <br /> L�.�-(7 �P. O p _ <br /> DESCN9E WOIIN <br /> '�1.�NF?�� J'NPROI/L'IYGTJt ,�CTI�/C. S7aQ�^� <br /> useoreuaon�c r � _ I r� I HEREBY CERTIFY THAT I HAVE- READ �tJD EXAMINED TtiIS AP• <br /> ���-���L � r/�Lcf. �/l 1" T3 pLICA710NANDKNOWTHESAMETOBEiRUEANDCORRECT.ALL <br /> l[G�LOESCR�P110NOFPPOPERLYISHOWNOEIOWORAIT�CNFOURCJPI s� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL GE COMPLETED WITH WHETHER SPECIFIED 11ERE• <br /> LO�.—BLOC1f_�-OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL TI1E PROVISIONS OF <br /> �`�� ��� ` � � .;�� ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNAIUREOFCONTRACTOROfiAUTHOPIZEDAGENi UAIE <br /> ElZ�r � ctirn. A•r,f�E. E✓cQr' i1cGc� <br /> {28 LfcOG ,6. X _ Rl�i (�SG, <br /> �� n"� APP�IGANiSCIiYDU51NESSlIGE SCNO <br /> I�ROJECI�O�NE55 r <br /> ioiz/ �d��4c�--� wn-�,av..-�--rr,oJA <br /> MECHANICAL — <br /> PLUMBING FEF. <br /> NO. TVPE OF FIXTUflE FEE NO. TVPE OF EOUIPMENT <br /> WATER CLOSET�TOILED QO ���COND.UNIiS—N.P.EA. _ <br /> BATHTUB GJ REFFIGERA'ION UNITS—H.P.EA. _— <br /> �AVATORY�WASH BASIW LO DOILERS—H.P.EA. _— <br /> GAS FIRED AC.UNITS—TONNAGE EA <br /> SNOwER <br /> KITCHEN SINKd DISP. FORCE�AIR SYSTEMS—B.T.U. M EA. _ __ <br /> WALLHEATERS—B.T.U. M _— <br /> DISHWASHER UNITHEA7ERS—B.T.U. M _ <br /> LAUNDRYTPAV <br /> C.OTHES WASHER EVAPORATIVE COOLERS <br /> � WATER HEATER OD CLOTHES DRYERS � �— <br /> URINAL Z VENTILATION FAN — <br /> �PINKING FOUNTNN RANGE tI00D -- <br /> 2 FLOOR OPAIN Q� AIR HANDI.ING UNIT— C.F.M. — <br /> STOVE — <br /> VACUUM BREAKERS <br /> � ROOFDRAINS—RAINLEADEFS METALFIREPLALEd CHIMNEY — <br /> SINK�SERVICE—BFR.ETC. WOO�STOVE/FIREPLACEINSERT — <br /> SUB TOTAL S �� <br /> SUBTOTAL s <br /> PERMIT S PEflM1T — <br /> TOTALFEE 3 <br /> � TOTALFEE S BU_ <br /> THIS PORTION TO BE COMPL�TED BY BUILDING DEPT. PERSONNEL <br /> PUNCNEGKNUMOER t P9tRNCHECKFtE �C� <br /> R10Nt5Et8�Ce (1EARSEIOPCN SIDESEIBACN FEE �J�O�I� RECEIPtNO. /� <br /> N./�. ,33 ,� .��.- _ <br /> 65E 20qE lOf ARE� VAC�NT SILE FEES VRLURTION FEE <br /> �� �/� ores �r+o <br /> LVi'EOFCONSI. OGCUPPNCYGpOUf NO.OFDWELLINGUNITS � i — <br /> Q'.� /j�Z. � oui�oiNc s`t4.(dp. � "S'C' SD <br /> 5�2E OG OLOf. ND.OF SI/RIES M4%.00G LOPD � - �l <br /> QQ PLUM8ING �� <br /> 3�00 5r• i�� <br /> MECHANICAL � da <br /> FIRE SPFiINKLERS REOUIRED ❑ YES NO OTHEn <br /> PENPLTY - __ <br /> pVPLICAl10NACC BY PLAHSGIIECNEDBY APPF_FORISSU/NCEBY �,4, � <br /> TOTAL <br /> }�2 � J� � � G <br />