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iti.'PLICATION FOF� <br /> ,".E"'°'"" CONSTRUCTION "� <br /> CITY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•88/0 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION Ijt BUILDINO O MECHANICAL ❑ PLUMBINa ❑ 91ON <br /> Qµry q �� p M�IL�DDRWS�: �' /� CitY �s.. IIP pBONE <br /> ✓ �G' a'(<- /` . �•nc�� C��• /{C.R� LT�rnlo��a.� /J/'. �-{'CI'P�l 74 ��jo3 ��5�7- J' 3S' �o <br /> •ncH�t[ctonutsimiEu � M����oon[ss prv iiv m�oHc <br /> �f�QS��inAG10R M�Il�U0RE5S C�1v !1:' vuONE uCENSE• <br /> L � �CP/Y �:r S4lasN_ OS ?6c ✓G <br /> . <br /> MECNI�NIGL CO4�P�CfOi� M�IL LpOALS$ GIIY ZIP PIIONE LICEN$f• <br /> �LUMBRIOCOftlP�G�OR MMI.�ODRE55 CIIY ZIP P�IUNE Lil'tNSE • <br /> LL�!'J Of WOAK <br /> ❑ NEW ��ODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLI110N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOC�itON <br /> , �w�iorvorwc��'�.to5�rn �uicnu�sr�us�eaon� ' <br /> r� <br /> I � �Y�C _ <br /> otscn�at wonn <br /> �/�neK <br /> USE O�BUiL0�N6 <br /> / Sro�y�� ���»�y F���' e I HER[BY CERTIFY IHAT I HAVE READ AND E%AMINED tfilS AF� <br /> PLICATION AND KNO\VTHE SAME TO BE TRUEANDCORRECT.ALL <br /> � it lOESCRiVt10NOFpqOPERiY�5110WN0ElOWOR�if�G11fOURCOPIE51 PROVISIONSC'FLqW:1ANDORDINANCESGOVERNINGTFiISiVPE <br /> � n OF WORK WILL BE COIAP�ETED WITH WHETHERSPECIFIED HERE� <br /> w��e�oc�o�1� � 'e� INORNOT.THEGRANfINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHOti1TY TO VIO�ATE OR CANCEL THE PROVISICMS OF <br /> I1NY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PE FA h1ANCE OF CONSTRUCTION. . <br /> SIGNRIUA FLONIiA�•OqOR fl RIZE�AGEN p�lE <br /> / <br /> , � z7��. <br /> PAOJEC1�ppRE55 - . �CP�If.�N�5C1iYBt151NC55U N9E�i <br /> �� /J / ��z.�� <br /> " l�cF'�-7 L/tn/rer en ��:� ��e/e�� ��a,�i. y'Clfs <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENi FEE <br /> WATER CLOSET�TOILET� A/C—A/HNDLG UNITS—H.P. <br /> BATMiUB NEFRIGEf1AT10N UNITS—17.P.EA. <br /> LAVATORY IWAS��BASIN� BOILEflS—B.T.U.MP. <br /> SMOWER GAS FIRED A�C.UNITS—B.T.U. <br /> KITCNEN SINK 8 OISP FOFCED I11F SYSTEMS—B.T.U. M EA. <br /> OISHWASHER WALLMEATERS—B.T.U. M <br /> LPUNORVTRAV UNITMEATERS—B.T.U. M <br /> CLO7HE5 WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHESORVERS <br /> DRINNING FOUNTAIN VENTILATION FAN <br /> FLOOR ORAIN RANGE NODD <br /> BIICKFLOW PREVENTERS WATE(1 HEATER <br /> FOOF DNAINS—�7AINLEADERS WOOD STOVE <br /> SINK�SERV�CE—OAR,ETC� METAL fIAEPLACE 6 CHIMNEV <br /> FIREPUICE INSEtiT <br /> HEATPUMP <br /> GAS PIPING <br /> E%NAUSTFAN <br /> SUlTOTAL f SUBTOTAL <br /> VERMIT f PERMIT <br /> TOTAL FEE f TOTAL FEE <br /> ���ovr SE�A�cK� nEAn 5et0�cK S�DE SEIB�CK ��H CN NUMBER FEE QG� RECEIP7 NO. <br /> _ �l� 1lS ��� �IOCq��, <br /> usc tor+e ior nnEe ypCRN sne FEES VALUATION FEE <br /> ❑YES�NO <br /> ��i''!��/r�ONSi OCCUP�NCYGROUP NOOiUWFLUNOUNIIS BUILOING SIZ�.� O`� <br /> y N M^ � � PLUMBING <br /> sizc ar ainr r+o ur s�onies Mns oct �ono � MECHANICAL <br /> loSo�PF�c N�4 N. /�- <br /> `/ OTHER <br /> FIRE SPRINKLERS REOUIRED O YES �R.NO rJ C , <br /> SiATE BUILDING SURCHAfiGE J ) <br /> STAIEENERGYSURCHARGE <br /> ^�'✓I�G�Ii01lnlC U� PL�NSC��ECNEDOY �PPq FOOISSU�NGEBY <br /> rusuc wor�Ks <br /> �� L . G• TOTAL ' 7 � <br /> i PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPER7Y LINE LOCATIONS AND RE�AIED EASEMENTS. <br />