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�r.PPLICATION FO►. ' ���,�„ <br /> '".E"'°""° CONSTRUCTION O <br /> ��r o. <br /> everett PERM IT <br /> zs9 BIN�O DEPARTMENT TO BE COMPLETED IN INK• PLEA3E PRINT (7(�L�� l���t('. ll. <br /> ❑ DEMOLITION � COMBINATION J�BUILDING ❑ MECHANICAL ❑ PLUMBING f r`��?OIsiGN <br /> owucn Mniienoness cnr z�r w�oNr �-. <br /> i - <br /> _r.�/�C: .�,vDGyiJ�r �sriti�.i AOG�� �ti - <<4:�,23 s_r-�s'.���'� <br /> u�uu¢c�onuisiunui MAq �D�t1159 r.nv ziv n��o <br /> ^, '- \ <br /> �`}� <br /> OkHERAL LO1rtMGlOA M�q�ODfiC55 C��Y Li� �PONE �Il;CNSE• <br /> /�� �,.v�PsiAU y�? �i 4E .� SiL�OrY. �.v�l. 9s�ya .f'G�-h-YO NrA�/.iR� /G�^G�_ <br /> 61t6urnf.��.CON1P�f,tUn ����1�1�oivC3s c�ir i�l• ru(?y{ liClqsi' . <br /> O�UMPINOCUNfMUOR MMI.FDD(VE55 CIIY ZU' P�IONE IICLHSI • <br /> Cl�!!Of WOPN <br /> ❑ NfiW ❑ A�DIiION � AITERATION ❑ PEPAIP ❑ OEMpLITION 0 WOODSTOVG/FRFL,INSERT ❑ BUIlDINO REIOC�fION <br /> J ' <br /> WIU�tIaNarwOnr�Co4�OrM �Inul4Pl.u9l�npry <br /> ����� <br /> I OElCRIOE WOR• � <br /> c> ' / ' D u/ODDsYOUE <br /> use or auao�Ho <br /> I HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED TI115 AP• <br /> � � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AIL <br /> lCO�L�ElCRiPf1pN0[OqOPERIY15110WN0ElOWOR�lUL11fOUf1COPIE31 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> .tOT e1 A,Vd i7Yfi .(ioR N d/ FC-t'T OF WORK WIIL BECOMPLETED WITH WHETIIERSPECIFIED HERE• <br /> io�—e�ocK_or r IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> ' m/� /�OT 3�/ '��6l�£C7l/ GL.BH iYLt!'�?DiNG SO SKE GIVE AU7�HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � ,P/�BT TK '(s/7EOF�/?EYORdNd i/d/,I/i� .YOF ANVO?HERSTATEORIOCALLAWREGULATINGCONSTRUCTION <br /> �/S� Pi9GE�� �E�/2i1t GF JA�dH, GG1YAd`Y OR THE PERFORMANCE OF CONSiRUCTIUN. . [� <br /> SIGN4IUFEDfCONIq4C10RO�AUfllOfll2[DAG[NI p4tE 1���'u � <br /> �or .� x . , / ` /, <br /> PAOJlC1�ODR!!! � 11PPLIC�N . YOUSINE99lICLN9CND <br /> �03 � G�c� i,� ,�•u��err �ui9. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F11(TURE OR ITEM FEE NO. TYPE OF EOUIPMENi FEE <br /> W�TER CLOSET�TOILET� AIC—AiMNpLO UNITS—H P. <br /> BATHTUB REFRI iERATION UNITS—H P.EA. <br /> UVATORY�WASH BASIN� BOIL615—B.TLIHP. <br /> SNOWER GAS FIRED AA.UNITS—B.T.U. <br /> KITCNEN SINK 6 DISP FORCED AIR SYSTEMS—B T U. M EA. <br /> OISHWpSHER WALLNEAlEi7S—B.T.U. M <br /> UUNORY TRAV UNIT MEATEfiS—B.T.U. M <br /> CLOiHES WASHER EVAPORATIVE COOLEPS <br /> UPINAL CLOTHES�RYERS <br /> ON�NNING FOUNTAIN VENTILATION FAN <br /> FLOOADAAIN RANGEHO00 <br /> BACKFLOW PPE�ENTEfiS WATER HEATER <br /> ROOF OAAiNS—i1AIN1,EADERS WOOD STOVE Q <br /> SINK�SEHVICE—BAR.ETC� METAL f117EPLACE 8 CHIMNEY <br /> ' FIREPIACEINSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> .ry� _ <br /> SUB TOTAI f SIIB T�l'�L g �j <br /> PERMIT f PCRMI: <br /> TOTAI FEE f TOTAL FEE <br /> mor�lSE�oecK� n[nnSEtoecK Sm[5[toeCK �ANCME KNUMBER FEE i AECEIPTNO. <br /> ��1 �1���0� �/C�`��� ,= 0:�=1 <br /> us[zo�+E ior�n[e <br /> v�cnrirsrte FEES VALUATION FEE <br /> RCS• [trEs�l++o BUILDING 5 � <br /> t'r�EOFC St OCCUFn4CVGR011P NO.OLOWELLINGUNIIS <br /> m9soN�� Fiar-'- <br /> �� L� R"� PLUMBING <br /> sitE or oioa �/ nn or somes MR% OCC lOep � <br /> �� P -Si�/�%T"��UL-� ��, MECMANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIR[D O YES NO <br /> SiATE BUILDING SURCHAFiGE <br /> STATE ENERGY SU�7CHARGE <br /> <�•��ucRnor�act e• ��inr+sc��Ecrc[onr mm� ronis5u�r+ceor <br /> t PUBLIC WORKS <br /> �[T'\ �C/ �'�� , TOTAL <br /> PROPERTY OWNERS ARE R[SPONSIBLE POR DETERh11NING ALL <br /> PROPERTV LINE LOCATIONS AND RELAi ED EASEMENTS. <br />