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m. er.,p,s.n <br />cin oc <br />everett <br />BUILDING DEPAaTMENT <br />259-8810 <br />4: :1f� <br />1��PPLICATION FOI�:j Ca�I Na'�p''s�'e+�a�-°� <br />CONSTRUCTION a+ ��i�-56�q `°e <br />pERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINAi IOW j� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />p�yNEq MRIlA0DFE5S C!LY 21P PHONE <br />SW��S,/JU� Zor��>Z l9"-`1 �tn1r SEA-rr��.�wn 9.��>s �Lz-ZZSS <br />dry�CqIIIIECiORDE5IGNEA / IAAIL�OORE55 LIfY Zli' PHONC <br />(NLQ��1�1f-.. �9h�S`W ��0. �oK �353 L�11JNlJOCU�W.I �Y03[_ 77�1_'li�' AL-U�-NG3C4 <br />GlNEflnL CONiPAG10R t�nML ApONE55 �� Cliv LIP PHONE LIGENSE � <br />'%,P�S�A-vR•�-r.�r5pn-c�c ilEiicti /S93SAI� � -' F�g-octv�c�wn ��c�6� E43-�aot, <br />MELNANIC�LGONIRPCiOfl M�Il4�DRE55 LITY 21P PHONE LICENSE• <br />PLl1MDWGCOMHAGiOB MAILnODRE55 CItY ZIP PIIONE UCENSE• <br />:U55 OF WORK <br />� NEW ❑ ADDITION ❑ ALTERA710N ❑ AEPA�R ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEfiT ❑ BUILDING RELOCATION <br />e iuiinunfwnnx�MSTnF�aRi[RIpLS^LUSLRBOPI <br />S,�n,�,NG C���- N�w r� <br />USE OF BUIL ING <br />S <br />LEGRI DESCRIPTION Of PROPERTY ISMOWN <br />5 Er .A�r'� A-t�fi'4� <br />wi� ewcr�—or <br />I y- u z <br />IOJEC)TPDDNE55 <br />VV �CA�.� IT <br />PLUMBING <br />S c e��ra.�rr <br />TYPE OF FI%TURE OR ITEM <br />WATEP CLOSET �TOILET� <br />BATHTU9 <br />LAVATORYIWASHBASIN� <br />$HOWER <br />KITCHEN $INK 8 OISP. <br />DISHWASHER <br />IAUNORYTRAV <br />CLOTHE$ WASMEfl <br />URINA� <br />ORINKING FOUNTAIN <br />FLOOH D�AIN - <br />ROOF OHAINS — RAINLEAOERS <br />SINK (SERVICE — BAR. ETCJ <br />� SIIBTOTAL f <br />PENMI! f <br />TOTAL FEE f <br />SEIBACN REnq SEIBACN SIDE <br />IE LOTRREA <br />/1� / <br />J <br />CONST. OCCUPRNf�' POUP <br />� -.V /�- Z <br />BIOG / NO.OF SiORIES <br />�d SG� � <br />VRGNT SITE <br />OVES '..}�i0 <br />APPR. <br />$ <br />:C. IOnD <br />� <br />Foo r� Ce� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EYAMINED THIS AP- <br />PLICATION AND KNOINTHE ShME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PAOVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONS?RUCTION <br />OR THE PERFORMi�NCE OF CONSTRUCTION. . <br />SIGNPTUREOFCONiP4C�pqORAU1HOFIZEDAGEN7 OATE <br />X ,' �`".�-^-,��y�-u-c,l. �� '��/d � j'.P <br />APPIIGNTS CITY BOSINE SS 4G6NSE NO <br />MECHANICAL <br />TYPE OF EOUIPMEN7 <br />A/C — A/HNOLG UNITS — H.P. <br />REFflIGERATION U41T5 — H.P. EA. <br />901LER5 — B.T.U./H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCEO AIR SYSTEMS — B.T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UNIT MEATERS — 9.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESORYERS <br />VENTILATION FAN _ <br />RnNGEHOOD <br />WATER HEATER <br />WOOOSTOVE <br />METAI FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />MEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAI. <br />PEHMIT <br />TOTALFEE <br />PLnNI;MECNNUMBER �FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARG <br />S7ATEENERGYSURCHARGE <br />PU9LIC WORKS <br />TOTAL <br />30 <br />VALUATION <br />S Lj C .�t <br />FEE <br />RECEIPT NO. <br />PROPERTY OWNERS ARE FiESPON5IBLE FOR DE7EHMINING ALL <br />PROPERN LINE LOCATIONS AND RELATED EASEMENTS. <br />