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.�:�.,k "�"-��:1 <br /> r�'�<�PPLICATION FO:�` ���,�„ <br /> r�"'" CONSTRUCTION e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8870 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL f7 PLUMBING ❑SIGN <br /> OWNEP M�IL�ODRE55 CIfY ZIP PHONE <br /> �j/4�fNL,r �A��C 10�15 EVERGICEI�JI/ �„bf�/ �Cl-J?c�rT <br /> �PCNITECTORDtS�ONEF MAILAODRE55 �iN ZiP PHON[ <br /> GENEMLCONTN�GTOP M�ILPDORE55 GiTV IIP oHONE LICENSE• <br /> MECM�NIGL CONTPAGTOq MUL�ODHESS CIIY Z�P PHONE 795T ��SE• <br /> L=��'�f�s �•s7C �.�r 3k/1 F{�.�CS �/J�mnf' 98Z�Y ?SZ3//y tU-,�e•63 S'3)SRE <br /> PIUM OCONTR�CTOF � M�IL�DORE55 CIfY ZIP PIIONE LICENSE• <br /> CLA9S OF WORN <br /> � NEW ❑ ADOITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDINC RELOCATION <br /> VALU�TIOH OF WORN�COSi OF MATENII�S PLUS LRBONI <br /> $ Za o��, � <br /> OESCpIBE WORIt �'�Ju� <br /> ev ( UWc+. s T�'�n o u ' �� *��S �N SNravic� Iln- � 'o <br /> USEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> � ��I'le S�ICfz'S PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AIL <br /> LEO�lDESCNIP110NOFVpOPERTYISHOWNBELpWOR�TTq�11F0URGOPIE51 pqOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �or_eioc�_ov IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . ' <br /> SIGNA7URE OF CONTR4CTOR OR FUII'ORI2E0 RGENT �qTE <br /> X ,(J,.0 � �-z�-g� <br /> FRQIEGT AODNE65 APPLIC�NiS CITY Bl151NE55lICENSE NO <br /> �(04'IS 7 $5`� GJ, <br /> PLUMeIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� - � • • A/C-�/HNDLG UNITS-M.P. <br /> BA7HnJg REFRIGERRTION UNITS-M.P.EA. <br /> LAVATORY�WASM BASIN) BO�LERS-B.T.U./N.P. <br /> g�{pyyEq GAS FIHEO A.C.UNITS-B.T.U. <br /> KITp1EN SINK 6 DISP. FORCED A�R SYSiEMS-B.T.U. M <br /> DISHWASMER WALL HEATEHS-O.T.U. M <br /> � uUNpqy Tq�y UNIY HEATENS-fl.T.U./ O�'�' M <br /> GLOTMES WASMER EVAPORATIVE COOLERS <br /> pp��� CLOTHES ONYERS � <br /> DRINI(INO FOUNTAIN VENTIUTION FAN <br /> ROOR DRAIN ' RIINGE.i000 <br /> BACKF�OW PREVENTERS WATEP HEATER <br /> ROOF URAINS-RAINLEADERS WOOD STOVE <br /> SINN(SF.iiVICE-BAR.ETC.) METAL FIREPLACE 8 CHIMNEV � <br /> FISEPUCE INSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> ' EXHIIUST FAN <br /> 3UB TOT/LL ! SUB TOTAL <br /> �ERMR f KRMIT <br /> TOTALFEE f TOTAIFEE <br /> {NONTSfTMCk RE�RSEiB�GR 9IOESETBl�G1t a.pNCMECKNUMBER FEE RECEIPTNO. <br /> USEIONE ��T�AE� VAC�NTSIfE FEES VALUATION FEE <br /> � pYES ONO � �� <br /> �lY'EOFGONST OGCIIP�NGYGROUP NO.OFDWELLIN6UNIi3 BUIi.DING S <br /> ' � PLUMBING <br /> SiZEOFl�DQ NO.OFgTOHIES M�%.OGC.LOAD <br /> � MECMANICAL <br /> O1HER <br /> FIRE SPRINKLERS REOUIRED ❑VES ❑ NO STATE BUILDING SURCHANGE <br /> STATEENERGVSURCHARGE <br /> �PPLIC11fION AGQ 8� VLANS CNECRED BV APPR FOR ISSUANCE BY <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTY OWNER9 ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY IINE IOCAT10N3 AND RELATED EASEMENTS. <br />