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f.PPLICATION FOI. ��«<n ' <br /> '".E""'"" CONSTRUCTION e <br /> GN�F <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUWIBING Q(SIGN <br /> OWNER M�II��ORlSS CIIY 2iP PMONE <br /> ofa�1 'h/tiric.s wc. Zi > >uzneTrn�� /3v:.�,rf 9F.�+� aSS�Ss-I sn..E <br /> �RCMITEGTOP�ESiGNER M�ILAOORESS CI1Y ZiV P��ONC <br /> GENEP�LGONTR�LIOR <br /> MAl1+000E55 Cltt LtP o��ONE LILENSE• <br /> /1tRw0o�u5�<Ns JSit S�s�rra �✓��-tl S'Fi.e�� 333-arss' Aef�csr�iD�G <br /> MECN�HIUICONiP�LTOq MeIl�0�RC55 Cltt 21P �MONE ULENSE• <br /> ��� � <br /> PWMBINfiCONTR�CTOR MAl1.ADDRE55 ��TM <br /> GU55 OF WORR <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br /> WLU�TION OFyt�OC�T O�ATEPULS P�US L�BORI <br /> I <br /> DESGRIBE WORR <br /> ,vS� tt �' Mnaueo � <br /> useorew�ou+c - I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• � <br /> PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL � <br /> i .ioes I TIONOi�HOPERTY�SMOWNOELOWOAATTACI�FOURCOP�E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �o�_a�o�„_,�F INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO i <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' ( <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF C6NSTFUCTION. . r <br /> SIGNAIUREOFCONIR�CTORORAUTHORIZEDnGENT OATE L <br /> x /Z..�s-Q..-.-- ��`��S! i <br /> •PPLIC�NT fIYO INESSLiCENSENO I <br /> PROJEGT�ODRESS .� ���� f <br /> 2�.t 3 � <br /> PLUMSIN6 MECHANICAL <br /> Np, TYPE OF FIl(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET ITOILETI A/C—A/NNOLG UNITS—tl P, i <br /> REfFIGEPATION UNITS—MP.EA. f <br /> BATMTUB <br /> UVATORV I WASH BAS111) BOILERS—0 T U/H P. <br /> GAS FIRED A.C.UNITS—B.T.U. <br /> SHOWER <br /> NITCMEN 31NK 6 DISP. FORCED AIN SVSTEMS—B T.U. M�FA. t <br /> OISHWASMER WALLFIEATEFS—BT.U. M t <br /> LAUNDRV THAV UNIT MEATERS—B.T.U. M {, <br /> CLOTMES WASHER <br /> EVAPORATIVE COOLERS � <br /> CLOTHESDRYERS <br /> URINAL <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> i <br /> RANGEHOOD � <br /> FIOOH DRRIN L <br /> BACKFLOW PREVENTERS WATEP HEATER { <br /> ROOF DRAINS—RAINLEADERS wOOD STO�E i <br /> SINK ISERVICE—BAR.ETGI METAL FIREPu10E 6 CHIMNEY <br /> FIPEPIACE INSERT <br /> HEATPUMP � <br /> GAS P�PINO � <br /> E%HAUSTFAN � <br /> i' <br /> SUlTOTAI f 5UlTOTAL • <br /> P[HNIT ' <br /> PENMIT f <br /> TOTALFEE f TOTALFYE ; <br /> ' PLAN CMECK NL'MBER FEE RECEIPT NO. . <br /> �AONTSEfB�CM RE�RSETBACN SIOESETB�CN � <br /> O � O f <br /> usE��e / �o�" v.ceNrsire FEES VALUATION �E � <br /> �� oves or+o S �� <br /> l. � BUILDING <br /> tYPEOFCONST OCCUP�NLYGROUP NOOFOWElLIN6UNITS <br /> , PLUMBING ��i <br /> S�ZE OF BlDO. NOAF SiORIES M�%OCG LO�O MECHANICAI <br /> I <br /> � � <br /> OTHER ; <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO _. STATE BUILDING SURCMARGE ; <br /> STATEENERGYSURCHARGE ( <br /> aPP�iLR110NACC Bv PlANSCMECNEDOY APPR FORISSOANGEOV PUBLICWORKS I <br /> �. <br /> TOTAL � <br /> PROPERTYOWNERS ARE RESPONSIBLE FOp�ETERMININ6 AlL � <br /> FROPERN LINE LOCATIONS AND RELATED EASEMENTS. I� <br />