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'��-- APPLICATION F+�R <br /> '"'E"`°'"" CONSTRUCTION ��e <br /> CITY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED !N INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION 7 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ]WNER / M�IL�O�PESS CITY J �ZiIP PMONE <br /> ' .'�- f � �� � f, r,_,. Lu _�1 � � n /��oi• � �7 71✓ZC�J �.��.J '�)t�).3 <br /> rRGNi EGTOROES�ONER��(' r, AIAILADOR[SS�'/�� / t�J CITY !-_� 21P PNONE <br /> iENER�LGONfP�G70R M�II�DDRE55 - Cltt ZIP PNON[ uCENSE• <br /> aECruNIC�LCONIR�GIOfl M�II��OBE35 CIIY ZIP P110NE LICENS'_• <br /> PWMBiN.CONIR�GtOR M�ILAODRE55 CITY 21P PIIONE UC[NSE• II <br /> CU55 Oi WORN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPA'R ❑ DEMOLITION � WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> v�1U�110N Oi WOAN�COST OF M�TERULS P�US UBOR� <br /> CESCPI/BE WOFN <br /> F i i ' � n ' � <br /> useor aui�oi' / / 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> {-/ ��-rv.� �i�•Jc � .-C: ..-, : �-• PLICATIONANDKNOW'fHESAMETOBETRUEANDCORRECT.ALL <br /> lEO�LDESCRIPt10NOFPROGERTY�SMOWNB IOWOF� 11 HFOIIRGOPIE PROVISIONSOFLF,LVSANDORDINANCESGOVERNINGTHISTYPE <br /> ��� OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br /> ior_.e�oc�—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CCNTR�CTOR OR AUTHORIZED RGEN7 � DATE <br /> X �/'C .:..✓ � L4 _ ii�„��r J L� <br /> oROJECT��DRESS . / APPU ANTSQTYBUS�NESSLIGENSENO. <br /> `�� �C/ .(�ClI"�:n �;._ �Gn � �[��rQ'l <br /> PLUMBIN6 �1ECHA171CAL <br /> NO. TVPE OF FIXTURE FEE NO. TVFE OF EOUIPMENT FEE <br /> WATER CLOSET I701LE7) AIR COND.UNITS–H.P.EA. <br /> BATNTUB REFRIGERATION UNITS-H.P.EA <br /> LAVATORY(WASH BASIN� BOILERS-H.P.EA. <br /> SHOWER GAS FIRED AC.UN�TS-iONNAGE[A <br /> KITCHEN SINK 6 DISP. FORCED AIR SVSTEMS-B.T.U. M EA. <br /> DISMWASHER WALL HEATEFS-B.T.U. M <br /> LAUNDRViRAY UNITHEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DflVERS <br /> URINAL VENTILAlION FAN <br /> DRINKING FOUNTAIN RPNGE HO00 <br /> FLOOR O(iAIN AIR HFNDLING UNIi- C.F.M. <br /> VACUUM BREAKEFS STOVE _. <br /> ROOF DRAINS-RAINLEADERS METAL F'IREPLACE d CHIMNEV <br /> SINKISERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTqI. SUB TOTAL S <br /> PERMIT t PERMIT S <br /> TOiALFEE f TOTALFEE _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �ROHTSEIOALK �EARSE78�CN SIDESE78�CK PL�NCNECNNUMBER PLANCNECKFEE � <br /> FEE RECEIPI NO <br /> USE 20NE lOi qPE� ypCANT5IIE VALU�iION FEE <br /> FEES <br /> OYES ONO <br /> tYPEOFCONST. OCCU�ANCYGROUP NO.UFDWELUNOUNITS <br /> BUILOINO S <br /> 512E Of BIDb. NO.OF SfOiVIES MAK OGG tOAO <br /> PLUM61N0 <br /> MECHANICAI <br /> FIRE SPRINKlERS REOI"RED ❑ YES O NO <br /> OTHER <br /> PENALTY <br /> aPP�IG110NRCC OV PLnN5p1ECNE�BY �PPR.FORISSU�NGEBY <br /> TOTAL <br />