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�� <br /> ,�.E�,,,,,� `r:PPLICARION' F N!:'�' ���,�„ :. <br /> ��TM�F CONST UCT 4 e . <br /> everett PERMIT <br /> BUILDING DEPARit,'ENT <br /> 259•8810 TO BE COfl1PLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SICaN <br /> ^W ���'� �� � �I��{ik55�o�1� GIiY 21Y PHONE �� <br /> _..N <br /> 1� Dr. ��(-e�r� a�- � <br /> ♦PCMRECI OR Dl51GNEB MML AOOhE55 ��n' ZIP PnONE <br /> G[NElULCOHTRAGiOH M4lA�pNESS CITV 21P PI�ONE LICENSE• <br /> �h��.� r�hara.Q f�AS - il3a� �Ica►,�v �t9- �re�e-�--�g�v�-.�s-77� V4�l�n�d �53L:Z_� <br /> MECNANi �\.N1F�CTOq M�LL�00 SS ��T�' Z�P PNONE LICENSE� <br /> V <br /> PWMBiNGCONiP�CIOP MAIL�DORE55 CIIY IiP PIIONE LICENSF• <br /> CU55 OF WOPN <br /> ❑ NEW ❑ ADDITION LTEiiATION ❑ REPAIR ❑ DEMOI.ITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> WLU�TIONOFWONNICUSTOiM�T RIA�SPWSI��ONI <br /> oes��El.1L l .. �Y' �—l'�-lX�l, a) ' � � <br /> use o� u�¢vwC`_, i 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br /> � PLICATION AND KNO1"THE SAMETO BETRUE ANDCORRECT.ALL <br /> LEG�LOESCP�PTIONO�PAOPENfV�SNOWNBE�OWOR�iTAGMFOURCOPiE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE- <br /> �o�—e�oc�—ov IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OF' <br /> ANY OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION : <br /> OR THE PERFORM"""��1ANCE OF CONSI RUCTION. . � <br /> 516NATURE OF CONT�OR AU MORIZED AGENT UATE <br /> X� � / <br /> �l/<'���? ��, ��v � �'� <br /> PROJELT�DORE55 / �PPLIf.�N'S I1YBu51NE53LICEN EHO <br /> "" �_ (�.0 ( ' )l-( 1/ I �r . <br /> PL MBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET ITOI�ETI AIC—A/MNOL6 UNITS—HP. <br /> BATMTUB REFRIGERATION UNITS—H.P.EA. <br /> UVATORY�WASN B�SIN) BOILERS—B.T.U.MP. <br /> SHOWER GAS FIRED A�C.UNITS—B.T.U. <br /> KITCHEN SINK 8 DISP. FORCED AIR SVSTEMS—B.T.U. EA. <br /> DISHWASMER 'NALLHEATERS—B.T.U. M <br /> LAUNORY TFAV UNIT HEATERS—B.T.U. M <br /> CLOTHES WASH'cR EVAPOHRTIVE COOIERS <br /> URINAL CLOTHES DRVERS <br /> DRINKING KOUNTAIN VENTILATION FAN <br /> FLOOH ORAIN N�NGE HOOD ' <br /> BACKFLOW PREVtNTEf15 WATER HEATEH <br /> ROOF DR�INS—RAINIEAOEHS WOOD STOVE <br /> SINN�SERVICE—BAR.ETC� MEfAI FIREPUICE e CHIMNEV <br /> FIREPIACE INSERT <br /> HEAT PUMP <br /> � GAS PIPING <br /> E%MAUSTFAN <br /> 3USTOTAL 3 SUBTOTAL <br /> VEPMIT f PLRWT � <br /> TO7Al FEE S TOTAL fEE <br /> � �nONI SEiO�Cn REA 1 SETBACK SI�E SETB�CN �AN CHECK NUMBER FEE AEGEIPT NO. <br /> ustior+� ior�ne� yAC�NTSITE FEES VALUATION FEE <br /> OYES ONO <br /> __ aui�owc s <br /> tVPEOFCf.YST OCCUP�NL 'NOUP NO.OFDWELLINGUNIiS <br /> PLUMBING <br /> 3i2C OF OLL6 NO Of SIORIES IAn%.OCC LOAO <br /> MECHANICAL <br /> O7HER <br /> FIRE SPRINKLERS REOUIREO ❑VES ❑ NO STATE BUILDING SUP:HARGE <br /> STATEENERGYSURCHAFGE <br /> aPpiiCp10N�CG 0� F.�NSL'NECNEDBY �PPR FORISSU�NCEBY <br /> PUDLIC WORKS <br /> I <br /> TOTAL ' <br /> PROPERN OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. � <br />