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'�;'�PPLICATION FO`�:' <br />'".E"'°"� CONSTRUCTION <br />an or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ �OMBINATION ❑ BUILDING �MECHANICAL <br />.......�.. Y�11 1�ONF65 i�.l n ZIP <br />Y <br />cin <br />IIP <br />❑ PLUMRING ❑ SIGN <br />PMONE <br />�ys'-Q9s� <br />PMONE <br />I4�ONE UCENSE • <br />3 - �,roo <br />PNONE tICENSE • <br />5�6F 7dZ Y fltlTl2 2 L, <br />P�IONE II�ENSE � <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPI.INSERT ❑ BUILDING HELOCATION <br />PROJECT <br />PLUMOIN6 <br />NO. TYPE OF FIXTURE OR ITzM <br />WATER CLOSET �TOIL <br />e�rHrue <br />LAVATORY IWASN 811 <br />SHOM/ER <br />KITCHEN SINN 6 DISP <br />DISNWASNEH <br />I,AUNDRV TRAY <br />CLOTHES WASMER <br />URINAL <br />ORINN�NG FOUNTAIN <br />FLOOR DRRIN � <br />BACKFLOW PPEVENT <br />ROOF ORAINS — HAI� <br />SINK �SERVICE — BAI <br />IRONTSE�B�C� <br />!U! TOT11l <br />PERMIT <br />TO�AL FEE <br />RE�RSETB�CK <br />BLD6 I NOAi STORIES <br />•VPLICATIONvV V <br />t <br />� <br />en <br />L <br />. <br />s��c au on�n <br />I HEREBY CEP.TIFY TFiAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFI�D HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GiVE AUTHORITY TO VIOLATE OR CANCEL THE FROVISIONS OF <br />ANYOTHER STATE OR LCCAL LAW FEGULATINGCONSTRUCTION <br />OR 7HE PERFORMANCE OF CONSTRUCTION. (+�J <br />SIGNAIURE OF CONTR�CTOR OR AUTI/ORIZEO ACENT pATE �U' �"O I <br />X �.�.� ��� <br />MECHANICAL <br />rrae oF eouiri <br />NC — �/MNOLG UNITS — H P. <br />NEFRIGERATION UNITS — N.P. 1 <br />BOILERS — B.T.0 iN.P. <br />GAS FIRED A.C. UNIiS — B.T.U. <br />FORCED Alq SYSTEMS — B.T.U. <br />WALL MEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CIOTHESDRVERS <br />VF.N7ILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOYE <br />METAL FIREPUCE 8 CHIMNEV <br />FIREPIACE INSERT <br />MEATPUMP <br />GAS PIP�NO <br />E%HnUSTFAN <br />SUSTOTAL <br />P[RMIT <br />TOTALFEE <br />P�AN CHECK NUMBER �FEE <br />V�CANi SItE FEES <br />OYES ONO <br />NO.OFDWELLINOUNITS BU�LDING S <br />PLUMBING <br />M�%. OCC. IO�D <br />MECHPNICAL <br />OTHER <br />STATE �UILO�NG SUR(:HARGE <br />STATEENERGYSURCHARGE <br />�PPR. FOH ISSU�NGE BY <br />PUBI�C WORKS <br />TOTAL <br />M <br />M <br />RECEIPT NO. <br />PROPERN OWNER5 ARE RESPONSIBLE FOR DETERMININQ ALL <br />PROPERTY LI NE LOCATIONS AND REIATED EASEMENTS. <br />