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� <br /> ;�:PP�ICATION FO►.. <br /> everen <br /> ��ry�'°'"" CVNSTRUCTION 1 e <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINAlION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> MRIL NODFE55 I CnITY �o ZIP( / PHONEn t� /J <br /> OWNER �J �7 (� ?�S�/��CJ �G��/t7 / �B�VS� �' .�I-/C> <br /> l�/�a. W DORF�'� �' /J� S:/�� �� CITV 2 P OYE <br /> � PqCMITEf.lOAl1k$�GNER MNILAOORC55 � ��� � ���� ��� ��C_� �/CC�`�/a�� <br /> c�,�u ����� r � �30� �3, y o�� � �.� <br /> MPiI>OOAE55 �T�' 14' ONh CENS <br /> GENERaLCUt{iRnLtOR �/^ /���5 Qa. �� C�7/ LyN/�(�f'N� j�?ayb � --Q'�JS L <br /> �/CcJ �CA� �^�'9Y t J �� <br /> c rv z n r oNe i cu sF <br /> MECHANIL4l COHiHPCLOq MAiI.ADDRE55 � <br /> El�c����a�9� lo���c�as v0. �o�c S03U �j.���oo Q�i�b 71a-os�S �l_Fr�;-�inoN <br /> PLU��BINO GONiR/CiOR � / / <br /> AURaDD��ESS �LiiY ZiV PMONC L�LENSE • <br /> � ecf��c� l �K��vu �•7ivcT�RS�U �a� S�3G �f�n�,J���P 96aYG 77cP-�355 ELEcTcUlQ2N <br /> c < sorwoNK. <br /> NE61' ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ 1'+OOOSTOVE/FRPL.INSERT BUILDING RELOCATION <br /> V URTION W �ICOST Oi MALCRIAL$PLUS LABCRI H JC�y—� <br /> �r�R a�- �' ������ r�ti 1 o,v-.,,✓ d,�;•� �-�� / <br /> DESCAiBE WJPN ` i, <br /> C ��. /N !D� L V <br /> use o�e ao� c , / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> ��� �W� � tt 1'C - PLICATIONANUKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEGALDESCAiPiiON ANOVERTY�SHOWN� OWORA�Taf, vouacoaies� PROVISIONSOFLAWSANOORDIN�INCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE� <br /> �o�—e�oc�.—ur IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> G�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF <br /> � �� "� �p � �_� _ ANYOTHERSTATEORLOCAILAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> 2 � SICiNATURE OF CONiFACiGR OR AUTNORIZE�AGENT OATE <br /> X � �.v i�� <br /> pPPL .ANT 11Y UUSINE55 UCLNiE NO <br /> PHOJECT�ODRE55 /� <br /> S � �i,,�i 2 6S0 /-z6--qy �x� <br /> MECHANICAL <br /> PLUMBING FEE <br /> NO. T'VE UF FIXTURE OR ITEM FEE NO. T/PE OF EOUIPMENT <br /> A/C—A/HNOLG UNITS—HP. <br /> � W�TER CLOSET ITOILET) <br /> REFRIGERATION UNITS—H.P.EA. <br /> BATMTUB <br /> BOILERS—B.T.U.�MP. <br /> UVATORY�N'ASM B�SINI <br /> GAS FIREO A C.UNITS—B.T.U. <br /> SHOWER <br /> FONCED A�F1 SYSTEMS—B T.U. M�� <br /> NITCNEN SINK 6 DISP �„� <br /> WALL HEATERS—B.T.U. <br /> Z DISHWASHER M <br /> UNI'f HEPTERS—B.T.U. <br /> LAUNOFYTRAY <br /> EVAPORATIVE COOLERS <br /> CLOTHES WASMER CLOTNES ORVER$ <br /> UA�NAL VENTIUITION FAN <br /> DR�NKING FOUNTAIN RANGE HOOD <br /> � FLOOR DRAIN <br /> WATEPHEATER <br /> BACKFLOW PNEVENTERS WpODSTOVE <br /> FOOF DRAINS—AAINLEAOERS M�7p�FIREPLACE 8 CHIMNEV <br /> SINK�SEPVICE—BPR.ETCJ FIREPLACE INSERT <br /> MEAT PUMP <br /> GAS PIPING <br /> E%HRUSTFAN <br /> 4UBTOTAL <br /> SUBTOTAL f p[RMIT <br /> PERMR s <br /> TOTAL FEE <br /> TOTALFEE : <br /> i'LAN I:MECK NUMBER FEE RECEIPT NO. <br /> 4RUNi5/E1B)ACh / AEARSf1B�CM / SIOESEiB�G1( / �� O � /� <br /> �/ �' �� G/ L <br /> l.iCJ � fEE <br /> use zonE � 7 ior^"E" vac��+*srte FEES VALUATION — <br /> � CYES JNO S � 2 <br /> �� �� <br /> 2 BUiLDiNG <br /> t�PLO�CO45t OCCUPRNGYGROUP NDOFCWFLLING^NI��GY <br /> — / ,�— ""'• PLUMBING <br /> J NO O�STORIES MAK OCC IUAU ��� <br /> 5i2E ov e n MECHANICAL <br /> 3003 sF�/L 2' ��� <br /> � O7HER ;�fi��G� / <br /> Z�3FIRE SPRINKLERS REOUIRE ES NO S7ATE BUILDING SURCMARGE -� �� <br /> STATEENERGVSURCHARGE <br /> :�+c��.:.LOuiC� �� �LANSCH G�OBv APCH FOFISSUANC6Nv pUBLIC�vORHS <br /> "O <br /> � TOTAL , � � � <br /> � �/ / � oqppERTYOWNERSARERESPONSIBLEFORDETERMININGALL <br /> I�ROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />