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i:. <br /> , PPLICATION FO�. � e��.�� <br /> `".`".,°`°'" CONST�tUCTiON O <br /> ��n 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 /> Owm�R MML�DDR[55 LIfV IiV PnONC <br /> Jll.� ',ll 'l. �'� �Iri ,�,, ��r:C •C�-JC-. t,.5:_:r'i!- � :ht (-o !�.(.'::-; L[:-.: .-�'yj ?}'.-- . .`U_ <br /> eNL1UtFC10ROL96N[N MMIApURE55 C�1V ZIP V��ONl. <br /> �� � <br /> GFNCPALCONiMG10P M�ILTppPE55 LIIY ZIY �'��ON[ ��CCNSC• I <br /> Q� � (<ui�D �� � i <br /> � MI.CIIP1YUlOpN N�CTOq ` M4LAODPE55 CtT 2 CC 1 <br /> Frr� � �I M S fZ� i RIF"�Cr7i/'� JN ' /�/u u%. %Ii�iin� .��� _ , � ., :�, ii;-1,7io ,cns�cl-i- �I <br /> H�C �"� PLIIMBIN6CONIR4CiOR M�It PDUPC55 CITV 1'� C CL ! / �/(/' <br /> K n <br /> E�� CLA550f WOPw. <br /> .� .q <br /> �W � ❑ NEW � ADDRION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Bl11LDING NELOCATION_ <br /> � '.�1A)A110N01"1\'ORn.LL SiOiA141CR14L5�'WSUAOPi <br /> � '!1`�c.,c <br /> �� nr scn i wo . . _ . �- <br /> l.ql fi1i�✓ /lli�C..i.ii/! ` �`�. f-�HiP' t- V✓'Y45i _'. Ci'. E.�'�5.r.:lTtt"/.'i !i:;Ci:c ✓cl�c.i,r,jsjn�.•.r. <br /> � , octHi/CA Jr(� rd. �/ i • <br /> Q��''''�1� use o�owim�+e I HER[BY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP� <br /> �y � /.'J/�riJ �FnCGt PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> � imaioe5cainnor+ocoaoveatr�SnowHoeiowoanirncHvouncoriEs pROVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> H, OF WORK WILL BECOMPLETED WITH WIIETHER SPECIFIED HERF� <br /> GO �o�—n�oc�--o� INORNOT.THEGRANTINGOFAPERMITDOESNOTf'RESUMETO <br /> �H GIVE AUTHORITY TO VIOLATE OR CANCEL TME PROVISIONS OF <br /> �0 ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br /> � OR THE PERFORMANCE OF CONSTRUCTION. <br /> �� SIGN41URfl OF CON111ACTGR OR AUTHORiZED AGENT 04t[ <br /> il � <br /> i� <br /> __ r X l/�:�; 4-,� �� .S'.2 7�� 7 <br /> qPruUmrS(:rtr�us�N[s5uclrv.EkO ' <br /> VROJECiAO�RE55 <br /> / . <br /> �/c-�c . '' L`-'L �/Y/"'iiril��C� <br /> PLUMBING MECHANICAL <br /> Np, �YPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE I <br /> . WATEP CLOSET�TOILET� ArC—AiMNOLG UNITS—H P � <br /> ' BATHTUB FEFRIGERATION UNITS—li P EA. I <br /> j� '. LAVATORYIWASMBASIN� BOILERS-0SU 4P <br /> I �� SMOWEfi GASFIREOAC.UNITd—BTU. I <br /> � NITCHEN SINK 8 D�SP FORCE�AIR SYSTEMS—B T U. M EA. � <br /> � f j DISMWASHEN NNLLHEATERS—BTU. M — I <br /> 1 LAUN�RYTRAV UNITMEATER$—OSL M I <br /> '�I�� � EVAPOPATIVECOOLEFS <br /> CLOTNESWASMER I <br /> I ���' UR�NAL CLOTHESORYER$ <br /> I VENTIIATION FAN <br /> ORINKING PCUNTAIN <br /> � PLOOF ORAIN RANGE HO00 _ <br /> IBACNFLOW PPEVENTEPS WATERHEATER <br /> ��� ROOF DRAINS—PAINLEAOERS �.'000 STOVE <br /> SINK�SERVIGE—9FR.ETC 1 METAL FIREPLACE d CHIMNEV <br /> fIPEPLACE INSERT <br /> '�.+ � MEATFUMP <br /> ' �. QAS PIPING <br /> � �� � E%HAUSTFAN � � <br /> SUBTOTAL S <br /> SUBTOTAL � <br /> � '' ' PERMIT f PERMIT � O <br /> `�' TOTAL FEE Q <br /> I — — _ TOT�IFEE f <br /> ���ONi5E�0�f.�. ��EAq5k10�Cn SIDESElO�GN <br /> i�LAN CMECK NUMpER FEE HECEIaT NO. <br /> � "��I��� usc to�+E im u�u v�r.urt sr[ rEES VALUATION FEE <br /> l� ❑res o <br /> DUILOING 5�� � <br /> nn�o.��sr OCCUPPIICYGi1DUP r�o oc oweiuHe mms <br /> `TT �/�?� �— PLUMBING <br /> �� <br /> s4f U�[3�0o No aF 9oNi[5 MAx OCC �MD MECMANICAL <br /> /� �3! 50 <br /> OTHER <br /> FIRE SPRI4KLERS qEOUIRED YES ❑ NO STATE BUILDING SURCHARGE <br /> STATEENERGVSURCHARGE �, <br /> u�:�i�c�.��ovncc9� �LeHSCnECnEDBY AI'�9ilORIS5l1ANGBOv pUBUCWORKS <br /> �_7 n L 'G' TOTAL <br /> d��Ci <br /> PROP[RTV OWNERS ARE RESPONSIBLE FOR DETERM!NING AlL <br /> � �� ���� �� PROPERTYLINELOCATI NSA RELATEDEASE�dENTS. <br /> i ��� —_/��� , <br /> tha��a�z��/1!U�� '��`Q � _ <br />