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i (5���., � ',� <br /> rw�PLICATION FO��� ���,�„ <br /> � '".E"'°'"" ' CONSTRUCTION e <br /> pTY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> � ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEP I I M�IL�UDR[55 / C�TY IP PHONE <br /> � h N�s �G.f h-G�w� lD�/ ��lwar�s �i-�.vy� _ <br /> •qCHtTECiORUFS�UNEN M�4AOORE55 C�n Z��' P��ON[ <br /> OE�E AL"L/pNfRSJ R M�II AO1O�E55 �/ I G�iv 1iP v��ONE LiCENSE• <br /> 1�-��I f'b Mr-rd '� �3 � L.bu��-r ��i dG � �iA �:rJGl�e}I� ,3sj- Yas'�� <br /> MECHRW.�LCONIP�LIOR MMI�DURE55 � CitY ZIP PIIONE LICENSE• <br /> r-������,���-3 yy � �- <br /> PLUMB�NOGONiP�G10B ��IL�U�pE55 Gitt LiP PHONE UCENSE� <br /> CUSS OI WOPn <br /> ❑ NEW ❑ ADDITION AL7ERATION ❑ PEPAIR ❑ DEMOIITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAiION <br /> WLV�LIONO�WO�M�COSIOF M�fERI�LSC WSLABON <br /> c� DO� � <br /> OESCFiBE W0 N <br /> .,,( �{ /'K U <br /> useorew�ou+o I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> '�v' ��� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEQ�LOESCA�P110NO�OpOPERIYI3HOWNBELOWOA�iTACy=oUNCOViesi, �� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> o �� OF WORK W�LL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �oi�eioc�—or IN OR NOT.THE GRANTING OF A PCRMIT DOES NQT PRESUME TO <br /> r GIVE AUiHORITY TO VIOLATE OR CANCEL THE PfiOVISIONS OF <br /> 4i ¢r{, ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNRTURE OF LONTRRCTOR OR RUTNORi2ED AGENT [IATE <br /> , X � ?. �� <br /> PXOJECT IIDORE33 ��PLIf.�NTS G f Y BUSINESS I�CENSE NO <br /> w <br /> PLUMOIN6 MECHANICAI <br /> NO. TYPE OF FIIITIIRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) NC—NFINOIG UNITS—H.P. <br /> . 911THTUB REFRIGERATION UNITS—N.P.EA. <br /> UVATORV I WASM BASIN) BOIlERS—B.T.0 M.P. <br /> . SHOWER OASFIREDA.C.UNITS—B.T.U. <br /> KITCHEN SINN 6 DISP. FONCED AIH SYSTEMS—B.T.U. M EA. <br /> OISFhN11SH�R WAIIHEATERS—B.T.U. M <br /> � LAUNORYTPAV UNITHEATERS—B.T.U. M <br /> � CLOTHESWASMER EVAPORATIVEGOOLERS <br /> I UN�NAL ' CLOTHESDRYERS <br /> I pqINNW6 FOUNTAIN VENTILATION FAN ' <br /> � FLOOR OR�IN NANGE HOOD <br /> � I BACKF�OWPFEVENTERS - WATERHEATER `� <br /> , i ROOFORAINS—RAINLEAOERS WOODSTOVE <br /> � SINK ISERVICE—OAR.ETC.1 METAI.FIREPLACE 8 CMIMNEY <br /> FIREPUCE INSERT <br /> � HEATPUMP <br /> � � OAS PIP�NO <br /> ; i E%NAUSTFAN <br /> i <br /> � � SUO TOTAI f SUB TOTAL � ' ' ' <br /> � � PERMIT 3 P[RMIT <br /> TOTAL FE! f T0TI1L FEE <br /> i <br /> fPONTSFIB�CR AE�RSET9�CR SiDESEtB�GK �NCHECKNUMBER FEE NECEIPTNO. <br /> f 1 <br /> use toNe LOi�RE� ���eNr s�t� FEES VALUATION FEE <br /> � .. . . OYES ONO - <br /> IYPEOFCONSf. OGGUP�NCYG(IOUP NOAFDWELUNGUNItS BUIL�ING S <br /> � � � PWMBING <br /> 512E 01'BLDO NO Oi STONES MA%OCC LO�O <br /> MECHANICAL <br /> O7HER <br /> FIRE SPRINKLERS AEOUIREO O YES ❑ NO SiATE BUIIDING SUfiCHARGE <br /> i <br /> 1 STATEENERGYSURCHARGE <br /> �. I�VpUCAiIIIN�CCipv PLANSCNEGNEDOY �FPN.iOR155uANCEOY <br /> i ���� / PUBLICWORKS <br /> ' `��V C� �� TOTAL <br /> PROPEFTY OWNERS ARE RESPONS�BIE FOR DElERMINING ALL <br /> � PROPERN UNE LOCAilONS AND RELATED EASEMENTS. <br />