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�4PPLICATION FOk'' <br />(�s EveiO��� C O N S T Gt U� T I O N <br />CITY OF <br />everett PEEtl1AIT <br />BUILDIhG DEPARTMENT <br />259-f,810 TQ� BE COMPLETED IN INK • PLLASE PRINT <br />❑ DEMOLITION ❑ COMBINATION l�BUILDING ❑ MECHANICAL <br />� <br />MSCH�N�f.4LCONiRPCiOfl <br />PWMpINGLONif1AG10R � <br />MP�L P0�lIE55 <br />N2�1lN *��, .712G . <br />rna� aooness <br />�. /'IFL°. <br />�u+'fc / <br />ZiP <br />evereK <br />� <br />❑ PLUMB�NG ❑ SIGN <br />PM')NE <br />�� �O ?l�- �Zl1 <br />;U�P��O E <br />�oG% �SS"-32�� <br />f`IIpNE LICENSF• <br />IICENSE • <br />CL4550i WORN J�/�T�,/J�///yj.d;H' /[r.L - <br />❑ NEW ❑ ADDI7"ION �AL7ERATIOfJ ❑ FlEPP.IR ❑ DEMOLITION ❑ 1NOOD5TOVE/FHPL.INSERT ❑ BUILDING RELUCnTION <br />VAL WTION OF W O��c% p$i O�TE(11R�5 PL�S LADOqL� <br />1'�� ��� V � 10 <br />i r <br />use or em�ou+c <br />idGo �irca.l� {m� <br />LEG�L OFSCRIPil000f Pq0'ENiY�SMO <br />L0�—OLOC���OF <br />PROJECT�OORESS <br />PLUMBING <br />Tl'PE OP FI%TURE OR ITEM <br />WATEN CLUSET �TOILET) <br />BATHTUB <br />LAVATOPY(WASH BASIN) <br />SHOWER <br />KITCMEN SINK 6 OISP. <br />DISHWASHER <br />LAUNDRVTPAV <br />CLOTHE$ WASHEfl <br />URINAL <br />ORINKING FOUNTAIN _ <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEACERS <br />SINK (SEFlVICE —BAR. El'C.� <br />�AONi5Ei0nCN <br />l, � � <br />ttPE OF f�5t <br />SUBTOTAI <br />PEfiM1T <br />TOTAL FEE <br />NEnN S�L9�Gn <br />iornnen <br />OCGUPRNCYGROUP <br />-r✓ i3 -'� <br />r NO OF SiOliiES <br />7 ST � <br />i1VVLICA`ION FGC <br />I NEREBY CERTIFY THAT I HAVE REAO AND EXAMINFO THIS AP• <br />FLICATION AND IWOW THE SAME N BETRUE AND CORRECT. ALL. <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH IVHETHER SPECIFIED HFRE <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOTPRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTFlUCTION <br />OR THE PEF.FORMANCE OF CONSTRUCTION. . <br />$IGNAiURE OF CONTRACiGR OR AU7HORRED AGENT DqTE <br />�,3 .����{�l �; �l ��,N,� s � . �� <br />�rPUL .^.cnrOriN 55LiCErv^ N ;L ��, .L�_ ���� <br />� //3yS G"�"� <br />nau� la•,xl'. ��. �+��..'a`r <br />(J MECHANICAL <br />FEE NO. TYPE OF EOUIPME <br />� A/C — A/HNOIG UNITS — M.P. _ <br />REPRIGEflATION UNIT$ — Y..F. EA. <br />VRGANL51_ TC�/ <br />❑YES �a6 <br />NO OF pWE:LII <br />�-- <br />MA% OCC. LOAI <br />CMEGKEf1f3Y RPPR(ORISSUFNLEOY <br />� !' ✓� <br />BOILEPS — B.T.U./H.P. <br />GAS FIREO A.C. UNITS — B.T.U. <br />FORCED AIR SYSTEIAS — B.T.U. M EA. <br />WALIHEATEPS—A.T.U. M <br />UNITHEATEP$—O.T.U. M <br />EVAPORATIVc COOLERS <br />CLOTMESOPYERS <br />VENTILAT1011 FAN <br />RANGEHOOD <br />' WATER HEKfER. <br />METAL FIR6PLACE 8 CHIMNEV <br />FIREPI.AC['NSERT <br />HEAT PU�'F <br />GAS PIPING <br />E%HAUSTFAN <br />5118 TOTAL <br />PERMIT <br />TOTALFEE <br />NUAIBER FEE <br />� `7i I la� <br />FEES � <br />BUiLDING S <br />PlUM61NG <br />MECNANICAL <br />OTHER <br />STATF EUILDING SURCHARGE <br />STAiEENERGYSURCHARGE <br />PUBLIC WO.�KS <br />TOTAL <br />FEE <br />RECEIPT NO. <br />R��a� <br />PRO�'ERTI' OYJNERS ARe FESPONSIBLE FOR DETEfiIdIN W G FLL <br />PROFERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />