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, . . _ . . . :�.. <br /> , � <br /> ��.E�ro�,� , �PPLICATION FO►.� ���,�„ <br /> ��n�F CONSTRUCTION e ' <br /> everett PERMIT ` <br /> BUILDING DEPARTMENT ; <br /> 259•eB10 TO BE COMPLETED IN INK• PLEASE PRINT � <br /> ❑ DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN � <br /> OWNER MAII AD�NE55 CiTY ZiP PHONE � <br /> _�N►i,a �. la�n�t , i�i� - �mlr�ncJ P�e. �vErF-H- 98ao3_ a4�-��iaa E <br /> �RCHITECTOROFSi6NER M�IL�OOPE55 Gltt Zi� P110NE <br /> C 1) Q � M�II e00RE55 G�fY I�� PHpNE uCENSE• � <br /> GENEP�L CONLRAQOR <br /> I <br /> MECN�NIGI CONTR�CTOq M�IL AOOPE55 CILY ZIP PIIONE LICENSE• �, <br /> PWMBINGCONTR�CiOR MML��DRESS G�TY Z�F PIIONE LICENSE• f <br /> C1�55 OF WORN ;� <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION � WOODSTOV FRPL.INSERT ❑ BUILDING FELOCATION � <br /> V��UATION OF WORR ICOST OF MATERULS PlUS UBORI � <br /> C <br /> DESCR�BE WONK , . � ` <br /> � <br /> ��SE O�G � <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEG�l0E5CRIPT10N GPROPERTY�SHOWNBELOWORAITACMFOIINCOPIE51 pqOVISION50FLAWSANDORDINANCESGOVERNINGTHISTVPE � <br /> OF WORKYlILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �oi_e�oc�—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO � <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL TIiE PROVISIONS OF ( <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSIRUCTION. . <br /> SIGNRTURE OF LONTR�CTOR OR AUTNORIZEO AGEN� PATE � <br /> X � <br /> PpOJECT�00HE55 AVPLIL�N :GITYBUSINESSUGENS . � <br /> I . � E � . � <br /> IPWMSING MECMANICAL <br /> I NO. TYPE OF FlIITURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF ClOSET ITOILETI A/C—A/MNDLG UNITS—H P. �� <br /> 2 <br /> BATMTUB REFRIGERAT�ON UNITS—H.P.EA. �, <br /> tAVATORV(WASM B�SIN� BOILEPS—�.T.U.MP. <br /> SHOWER GAS FIREO�C.UNITS—B.T.LL �, <br /> KITCHEN SIhK 6 DISP. FURCED AIR SYSTEMS—B.T.U. M EA. � <br /> DISHWASHER WALLHEATERS-9.T.U. M � <br /> UUNDRViRAV UNITHEATERS—B.T.U, M ' <br /> f <br /> CLOTHE$WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTNESDRYERS ' <br /> ORINKING POUNTAIN VENTILATION FAN � <br /> PLOOR DRAIN RANGE HOOD <br /> BACKFLOW PREVENTERS WATER MEATER � <br /> j ROOF DRnINS—AAINLEAOERS WOOD S70VE � <br /> � SINK(SERVICE—BAR,ETCJ METAL FIREPLACE 6 CHIMNEV � <br /> FIREPLACE INSERT ; <br /> , HEATPUMP i <br /> � GAS PIPING _ <br /> � E%HAUSTFAN _ � <br /> SUBTOTAL f SUBTOTAL � <br /> i <br /> 7ERMIT t P[flMIT <br /> TOTAL FEE f TOTAL FEE <br /> iHONT SETB�LN FEAR SET9ACK SiDE SEtB�CK � ��AN CMECK NUMBER FEE RECEIPT NO. <br /> 1 <br /> � <br /> USEZOHE LOiApE� VAC�Ni51TE FEES VALUATION �E •� <br /> F <br /> OYES ONO � '� <br /> BUILOING 5 i <br /> IVPEOLCONST OLCUPANCYGFOUP NOOFDWEIIINGUNITS <br /> � PLUMBING S <br /> i <br /> 512E OF BIDb NO Of SiOPIES M�%OCC LORD MECHANICAL � <br /> � e <br /> P <br /> QTHER ' <br /> I <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO STATE BUIL�ING SURCHARGE 6 <br /> �• <br /> STATEENEFGYSURCHARGE 4. <br /> APPUGATION�LG BY PlANSGMECKE�BY •PPR.FORISSU�NGEOY pUBLICWORNS 1 <br /> i <br /> TOTAL <br /> PROPERN OWNEfiS ARE RESPONSIBLE FOR DEl'ERMININO ALL <br /> pfaOPERTY LINE LOCATIONS AND FELATED EASEMENTS. <br />