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� - � <br /> 5��,�� <br /> ,.:���. �PPLICATION F�. everen S <br /> " '".E"'°'"" CONSTRUCTION O , "� <br /> � CITY OF <br /> everett PERMII� s <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING IGN <br /> .a,:! OWNER N�ILPODRE55 LIiY bP PNONE <br /> '� _�,��ticA�k2v �vsUo s�c�!9y s c�E��r 9Pszo4 s9-� - 3�4-� <br /> , 4NCHIiECtON0E51GNER MAILAD�R[55 CIiY ZIP PMONE <br /> GENERALCONiR�G10P MAILAOCR[55 CIiV 21P �'��ONE UCEHSE+ <br /> Mec��co��oq�J/xltS�l �'J� /1LOi� ST• Sc7�• 9�/�9 Z�4•�4ro TL�3cf1Ox 3ll�QS <br /> MAILAOORE55 CIi� ZIP PIIONE I�LEHSE• <br /> t <br /> u�y H <br /> Lt�� PLUMBINGCONTP4CiOR MAILApDRE55 G�TV ZIP PHONE LIC[NSE• <br /> Ci7 <br /> p�x LL�SS OF WORK <br /> C,ay yy ❑ NEW ❑ ADDITION ALTERHTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> y �H VAWA1iONOFWOPMICOSiOfM1IFiCRIPL5PLO5LA80Rl <br /> � ��� <br /> � n <br /> y� �ESCflIB[WONN <br /> � y H �o�� �esn���r v.�c-� cshC �/�cf <br /> � �� USEOFBWLDirvG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS:IP� <br /> /ts PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT.ALL <br /> rJ IEGALDESCPIPiIONOFPqOPER1Y15NOWNbELOWORFTTPCMFO11flCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> O M�y OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIEO HERE- <br /> N �]C lOT_.BLOG�—OF INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> 'n� C� �� �`�'� ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> � y 3 OR THE PEFFORMANCE OF CONSTRUCTION. <br /> � <br /> �� SIGNRTIIRE OF CONTRACTOR OR AUTHORIZE AGENT OATE <br /> N <br /> gN X <br /> N /-Gt- �o <br /> � � PROJECTAODRESS APPULANTSCITYBU ESSLI SENO. <br /> y� /OS'r,e� l{v��'9 S ' <br /> y �� PLUMBING MECHANICAL <br /> NO. TYOE OF FI%TUNE FEE N0. TYPE OF EOUIPMENT fEE �. <br /> WATERCLOSET�TOILEn AIRLOND.UNITS-H.P.E0. � <br /> BATNTUB REFRIGERATION UNRS-HP.EA. �� <br /> LqyATORY�WASH BASIW BOILERS-H.P.EA. �_ ', <br /> SHOWER GAS fIREO AC.UNITS-TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCED AIR$YSTEMS-B.T.U. M EA I � I <br /> ��` � OISHWASMER WAI'_MEATERS-B.T.U. M <br /> ' ! LAUNDRYTRAY UNITHEATERS-B.T.U. M <br /> CLOTMES WASHER EVAPOPATIVE COOLERS <br /> WATER HEATER CLOTHESORVERS <br /> �.r � �R�NA� VENTILATION FAN <br /> w ! DRINKING FOUNTAIN RANGE HOOD <br /> fIOOR DRAIN AIH HANOLINu UNIT- QF.M. <br /> � VACUUM BREAKERS STOVE <br /> f�"� � METAL FIREPLACEII CHIMNEV _ <br /> ROOF ORAINS-PAINLEADERS <br /> '� ! SINKISERVICE-BAR.ETC.1 WOODSTOVE/FIREPLACE INSERT _ <br /> � <br /> �� ! <br /> SUBTOTAL SUBTOT�L S I <br /> PEflM1T S PERMIT S <br /> j TOTALFEE 3 TOTALFEE s <br /> ..,m .r — <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNtL <br /> FpONiSELBRLK PE/•RSETOACN SIOESETBAGN PLANGMECNNUMBER PL?NCNECKiEE <br /> ��� fEE RECEIPI NO <br /> USE20NE LUinREA yeC�NT51iE <br /> FEES V�LU�TION FEE <br /> ❑vE5 �NO <br /> ��� �! <br /> iYPEOFLONSi. OCCUPRIICYGROUP NOOFOWELLIYGUNITS <br /> BOIL�ING s <br /> 52E Of 9LDG NO OF SLORIES MA%OCC.IOAD <br /> PLUMBING <br /> MELHANICAL I <br /> FIFE SPRINKLERS REOUIRED ❑YES 0 NO <br /> OTIIER <br /> PENALTY <br /> APPLiC411�NACCBv PLANSLNECNEOBY APFRFO�UAHCEOY � <br /> � TOTAL ` � <br />