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.• en. ev�ror«n <br />cin or <br />everett <br />BUILDING DEPARTMENT <br />269-8810 <br />d:M :y:� <br />i�i� PLICATION FOh°�= <br />CON�TRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION �COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEP MML 11DDHE55 C�il' ZIF PHONE <br />�ir-o.c�co aa w�4 /�.39 .�t,o� �c�r-f� ga,os s�li�8z.�3 <br />ARCMIfEGTON0E9�ONEH MMLAODAE55 CITY 21V PHONE <br />� _ <br />6ENER�L CONTR�C�ON M�It eU0RE55 C�ir SIP vHONE IICENSE • <br />�/Mtil- �rE�AE� I�SeL <br />MECH�NIC�LCONTR�LTOq MML�ODPESS Cltt LIP PIIONE 4CENSE• <br />�DOAE55 <br />CIIY 21P PIIONE <br />PrtF .isYM� 7�O�lJ•��'kina EUE.CET'f' 9ffldi �t/�'�/S3 � <br />WOR1( <br />NEW ❑ ADOIT�ON ❑ ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FHPL.INSERT <br />TIONOFWOAN�COSTOFM�yiR1�L5PlUSU�OR1 � � ^^N `� <br />-Li.si de <br />�� <br />PLUMSIN6 <br />�� � NO. � TYPE OF flXTUR! OR I <br />WATER CLOSET (TOILET) <br />9ATHTUB <br />UVATORV �WASM BASINI <br />SNOWER <br />� � KITCHEN $INK 6 DISP. <br />�� � DISMWA9HER <br />��� - UUNORY7RAY <br />� CLOTNES WASHEfI <br />� UNINAL � � - <br />' ORINKINCi FOUNTAIN <br />� �� FLOOR ORAIN • <br />. � BACKFlO'N PREVENTERS � <br />'��i ROOFDRAINS—NAINIEADERS <br />. SINK ISERVICE — BAR, E7C.1 <br />. SUB TOTIIL <br />VERMIT <br />i� ' TOTAIfEC <br />•.iRONiSEtBI�GN FE�RSETBACK <br />zo� � <br />.I1SE ZONE LOT �RE� . <br />f:-Z <br />IYPE OF LO T OCCIIP�NGY <br />��., . � <br />�SRE OF BlDO � � NO.OF STOR <br />� /060 S. F, I <br />FEE <br />5� <br />�NTSIiE � . <br />ts oNo <br />OFpWELLINO VNI <br />� <br />NaQ <br />UGRiION�CG B� IPLANSL'HECNE�BY PPPR.FO(1155WNCE <br />� � L.G <br />❑ BUILDING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ".HIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK W�LL BE COMPLETED WITH WHETHER SPECIFIED HEHE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PREEUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL I.AW REGULATING CONSTRUCTION <br />OR THE PERFOFMANCE OF CONSTRUCTION. . <br />SIUN�TURE OF CONTRqCTOR OR aUTNOfiiZED A6ENT C�TE <br />X 'u-�-:f ,A��tla�(� l�-I-B� <br />APPLICANTS CITY BUSIYE55 LiCEN9E Nfl <br />MECHANICAL <br />NO. T'PE OF EOUIPMEN7 FEE <br />NC — NMNDLG UNITS — H.P. <br />NEFR��ERATION UNITS — H.P. EA. � <br />BOILERS — B.T.U./H.P. <br />OA$ FIRED A.C. UNITS — B.T.U. � <br />FONCED AIR 9YSTEMS — B.T.U. M Fi1. <br />W��LHEATERS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHE9DRYERS <br />VENTIUTIONFAN � <br />NANGEMOOD <br />WATER HEATER : � <br />WOOD STOVE <br />� ETALI�fl��tCHIMNEV <br />FIREPLACE INSERT <br />HEATPUMP � <br />OAS PIPINQ _ <br />E%MAUSTFAN <br />St18 TOTAL <br />PERMIT <br />TOTALfEE <br />� PLAN CM CK NUMBER FEE �C RECEIPT NO. <br />s� iq�a� �id ° `� 3803 <br />FEES VALUATION FEE <br />BUILOING S �. � <br />PI.UMBING <br />MECHANICAL %_ <br />OTHER <br />STATE 9UILDING SUFCHARG' <br />STATEENERGVSURCHARGE <br />PUBLIC WORKS <br />TOTAI <br />PROPERTV OWNERS ARE RESPONSIBLE FOR �ETERMINING ALL <br />PROPERTY LINE LOCATIONS AND REIATED FASEMENTS. <br />