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p'�PPLICATION F'Of: �' ��t,�„ <br /> '".`"'°'"" CONSTRUCTION e <br /> an oc <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ,�BUILDING 0 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �, E� M�IL�DOR[55 CIIY 21P P��ON[ <br /> n9 .W �c._ `772� �ASu 5 i. (c.'U�,�Tr ��a'�3 353-t/ 813 <br /> •RCNitEGTOR�E.,IONEN M�iIADORE55 C�tY LP PNONE <br /> 6�f ENAI GONiR�GTON MAiL AD�RE55 G�*Y ZiP vHONE LICENSE• <br /> K�r�� PR�v � �S�Dr�� �3��6 2�n� 5��, S�,��.e, �839� l- 8oa56Z$10y <br /> MECNIINIG�ICONiR�GTOq M�IL�DORESS CIiY 210 PIIONE LiCCNSE• <br /> �l.viP�/9 7CF <br /> FLUMBiNOCONiR�CTON M�IL��ORE55 CItY LiP i'110NE UCkNSE• <br /> GU550�WORN <br /> ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BU�IDING REIOCAT�ON_ <br /> V�lU�T10NOFWORKIGUSTOFM�TEPIALSVLU �BOA� <br /> �085� � �- <br /> DESGPIBE WORK <br /> n� ���r D� o F �no �v N �rN o��F <br /> useo�w'�na_ 1 HEREBY CERTIFY THAT I HAVE REAU AND EXAMINED THIS AP• <br /> �-r�_ PUCATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> IEO�LOESCRiPTiONOFVpOPERTY�SMOWNBEtOWOR�11�C11i0URCOP�E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE• <br /> �oT—e�oc�.—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> ,y GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF <br /> 7t o7II D b^ 7�+ EJ Q-<< / H �a ANY OTHER STATE OR LQCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. n /�/� <br /> (.OUCi � y' '� � � SIGNAIUREOFCONiRACTOPOAAUTNOPIZEDAGENT pATE �-�'7'Z/�J <br /> X 7 -(Gdf7k2 P", <br /> PPOJEGT�DONESS PPPUC� �SGfVOUSINE55UGEN5[NO <br /> ��7�� �sy �,-, ���en cvr� 98ao3 D�o3i <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM FEE NO. TYPE OF EdUIPMENT FEE <br /> W�TER ClOSET�TOILET� A/C–A/HNDLG UNIT$–MP. ' <br /> BATHNB REFRIGERATION UNITS–M P.EA. <br /> UVATORY(WASM BASIN) �OILERS–B.T.U./M P. <br /> SHOWER GAS FIRED A C.UNITS–B.T.0 � <br /> 1(ITCHEN SINK 6 DISP. FORCED AIR SY57EM5–B.T.U. M EA. <br /> D1511WASMER WALLHEATERS–B.T.U. M <br /> LAUNDRYTRAV UNITHEATERS–B.T.U. M <br /> CIOTHES WASHER EVAPORATIVE COOLEFS <br /> URINAI CLOTHESORVERS <br /> DRINKING FOUNTAIN V�NTILATION FAN <br /> FLOORORAIN RANGEMOOD <br /> BACNFLOM�PNEVENTERS WATER MEATER <br /> NOOF DRAINS–RAINLEADERS WOOD STOVE � <br /> SINK(SERVICE–BAR,EfC.� METAL FIREPLACE 6 CHIMNEV _ <br /> FIREPLACE INSEPT <br /> HEATPUMP <br /> GAS PIPING <br /> EXHnUSTFAN <br /> SUS TOTAL f SUB TOTIIL <br /> PEpMIT f PERMIT <br /> TOTAL FEE f TOTAL FEE <br /> FRONt SETB�CR RE�R SEIB�GN SIOE SETBeCR � �AN CHEC NUMBER FEE FECEIPT NO. � <br /> Zp • � - � � �;� a�a��� �� �c�a i <br /> USE20NF LOTARE� y�C�NT IiL FEES VALUATION FEE <br /> ��1 �YE5�10 � /�/1 <br /> T�'PEOFfj1Y5f. OCCI��NCYGROUP NO.OF�WELlIN011NIT5 BU�LDING S ��� <br /> � " (� � ..- ' �� PLUMBING <br /> SRE OF BL00 NO OF STORIE M�%.00G LOAO <br /> 3�, �� � �� MECHANICAL <br /> JTHER <br /> FIRE SPRINKIERS REOUIRED O YES NO STATE BUILDING SURCHARGE <br /> STATEENERGVSURCHARGE <br /> •VVLILAIION�CCB� PL�NSGMECNEOBY �PaR.FORI55U�NCEOY <br /> � /1 PUBLIC WORK3 <br /> �I /,.LC� TOTAL � � <br /> 1 <br /> PROPENTY OWNERS APE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTI LINE LOCATIONS AND RELATED EASEMENTS. <br />