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N�Evoprwn <br />C�tt OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />(��PLIC�ITI�N FOk�' <br />CONSTRUCTION <br />PERMIIT <br />TO BE COMPLETEQ IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MEC4ANICAL <br />_....._� uau nnnn[[5 Cltt ZIV <br />� <br />�f PLUMBING <br />PHONE <br />everetl <br />e <br />❑ SIGN <br />PFCHIfEGiOB�ESiGNER " MniLnuunCss �n• . u. r..�nc ��ys "C� <br />$S?/7�do 355 o/yl <br />GENENAL COMRPGIOR IAAIL �OORES3 CIIV IIP PIIONE � LICENSE • <br />�d6 p h�� <br />M[L1IANILALCONTPAGiOq M1UILAODl1E55 CIiY 21P ]IIONE LICENSE• ' <br />PLUM9INGLONTNACiOR MAILADDRE55 CIiV ZIP PIIONE LICENSE• <br />GLR55 DF WORK <br />-Q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING FELOCATION <br />VNLUATtON �)F N'OBK�COST OF MAiCRIR:S �LUS LAOORI <br />1YOFN <br />usE oF Bu1Lo�M1 . <br />IEGRI <br />�E�OW OF <br />��}025� �v��.'h'il 1'11i\\�'qV <br />PLUMBING <br />TYPE OF FI%TURE OH <br />WATER CLOSET �TOILET) <br />BATMTUB <br />LAVATORYIWASMBASIN� <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />OISHWASHER <br />LAUNURVTRAV <br />URINAL <br />fLOOR ORAIN � <br />BACKFLOW PflEVENTEHS <br />ROOF DFAINS - RAINLEADERS <br />SIN7< (SEP.VICE - BAR. ETG) <br />iNpNi5E1BACK <br />SUBTOTAL <br />PERMIT <br />TOTRLFEE <br />NEnR5E1BACK <br />USEtONE LOiAPEA. <br />11'PE OF CONST. OCCUPANCY GROUP <br />SIZEOiBIDG NOOfSiORIES <br />FIRE SPRINKLERS REOUIRED O YES O <br />RYPUGAiIONACC.BY PLr1N5CMECNE00Y <br />� /� � <br />�J <br />v �� -..� na �* r n �� c. N3i,r '� rn �t .� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WOAK WILL BE COMPL.ETED WITH WHETHER SPF.CIF!ED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUT;iORITY TO VIOLATE OR CANCEL TI1E PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />(�R THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF GONiRACTOR OR AUTMORIZEO AGENT pAiE <br />pPPLICAN-�I��ICE111� � � l�^� 1 � <br />MECHANICAL <br />FEE NO. TYPE OF EOUI� MENT <br />A/C -A/HNDLG UNITS - H.P. <br />REFRIGERATION UNITS - H.P. EA. <br />BOILERS - B.T.U./H.P. <br />GAS FIFlED A.C. UNITS - B.T.U. <br />FOPCED AIR $YSTEMS - B.TL. M EA. <br />WAIIMEATERS-B.T.U. M <br />UNIT NEATERS - B.T.U. M <br />ECAPORATIVE COOLERS <br />CLOTHES DRYEAS <br />VENTIIATION FAN <br />Q, 00 AANGE HOOD <br />. WATEH HEATER. <br />WOODS70VE _ <br />•.cST 00 METAL FIREPLACE d CHIMNEV <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />S � p0 SUBTOTAL <br />f ' �- p? PERMIT <br />S S� � TOTIIL FEE <br />il�E SEiBnCK - P�AN CHECK NUMBER FEE <br />1 <br />vacerrtsrte FEES �A�•� <br />�YES pN0 <br />BUILOING $ <br />40. OF CWEILING UNITS <br />PLUMBING <br />AUX.00G LOAO <br />MECHANICAI <br />APPq.FORiSSUANLE9Y <br />OTHER <br />STATE BUILOING SURCHARGI <br />STATEENERGVSURCHARGE <br />PUB�IC WORKS <br />TOTAI <br />PECEIPT VO. <br />PROPERN OWNERS ARE RESPONSIBLE FOR DETERAIINING ALL <br />PROPERN LINE LOCATIONSAND RELATED EASEMENTS. <br />