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;) ,_w <br />L �� <br />PPLICATIOfV FOi. ` <br />,".E"`°`"° �ONSTRUCTION <br />Ci�Y OF <br />everett PERMIT <br />BU�LDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITIQN ❑ COMBIMATION ❑ BUILDING ❑ MECHANICAL <br />n <br />c�c�a�- <br />flCt OR �FSiGn <br />3 � f11� i?R� <br />�irc <br />❑ PLUMB!NG <br />WA. �a % <br />� PNONC <br />;�Od �20'--5�, <br />evrren <br />� <br />yavl�arv emuanit <br />/ i1 <br />[i <br />n - 6�� /iC4.r� .. <br />L� P .� C° � o a _ i a..�� .���,..,.. - -- — � <br />M[CIIANIfiI CONiHPCi )q 1 UAIL PO�R[SS CIiV LIP PHONE ���CENSE • <br />PI.UMBItIGCONiNnQOA MP11.40�PE55 Cltt 21P PI�ONE uCENSE • <br />lOi WONM <br />NEW ❑ AD6ITION ❑ ALTERATION ❑ R[PAIR ❑ DEMOLITION ❑ L1'OODSTOVE/FRPL INSERT BUILDING REIOCAT�ON <br />�➢ONO�WOR5ICOSTOfMaiEFiALSPWSLFBPPI �U> <br />f�� �/� O Cl _ � <br />�m—e�oc�_ <br />PROJECi AO�RIiSS� / (� <br />� <br />YJ <br /><56�"c S . �, � � <br />PLIJ M@IN G <br />ryp, TYPE OF FI7 <br />WATER CIOSET �TOILI <br />BAT/tTUB <br />LAVATORYIWASHBA: <br />SHOWEH <br />KITCHEN SINN d OISP. <br />OISMWA$IiER <br />LAUNDRVTPAV <br />CIOTHES wASHER <br />URINAL <br />DRINNING FOUNTAIN <br />Fwon oaniu <br />BACKFLOW PREVENT. <br />ii00F DRAINS �-PAIP <br />' SINK �SFRVICE - BHF <br />�..� 1 <br />'� r <br />��, . <br />I <br />� 1�1 :! �RONi5Ei8ACN <br />_ t <br />u ;E to�E <br />� <br />rcP[OFCONSi <br />sas ov eioc <br />F <br />af.0 �v <br />OR <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />REAR SEiBALN <br />LOiARER <br />OC W PnNCY GFOOP <br />NO OF SiORI[5 <br />RED ❑ YES ❑ <br />IP�ANSCNEGHEDBY <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BETRUE AND CORRECT. ALL <br />cowes PROVISIONSGFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILlB_COMPLETED WITH WHETF'.ERSPECIFIED HEFE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />Op THE PERFCRMANCE OF CONSTRUCTION. . <br />SIGNFtUiiE OF CONTR4CiOA OA AUiHORiZF.D AGENT f]ATE <br />X�%�.,, � �� ///y/�� <br />APPLIOb��TS CILY OUSINESS L�CE1lSE N� <br />� 0'19�fS <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />A/C - A/HNDIG UNITS - HP. <br />REFRIGE� �ATION UNITS - H P. EA. <br />�OILERS - B.T.0 MP. _ <br />GAS FIREO A.C. UNITS -� T.U. <br />FORCED AIR SYSTEh15 - B T.U. M EA. <br />WALLIIEATERS-B.T.U. M <br />UNIT MEATERS - B.T U. ti� <br />EVAPORATIVE COOLERS <br />CLOTY.E3 CRVEnS <br />VENTILATIOIJ FAN <br />RANGEHOOD <br />WHTER MEATI:R _ <br />WOODSTOVE . <br />MEfFL FIREPLACE d CHIMNEY _ <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />I E%HAUSTFAN _ <br />s � SUB TOTAL <br />S PEHMIT <br />s 70TALFEE <br />„�,,,,,,,, ' � PLAN CMECK NUMBEfl � FEE I AECEIPT NO. <br />ypCpryT SIiE <br />❑vES ONO <br />OCC LOPO <br />BU�LOING S <br />UNILS <br />PLUMBING _ <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />$TATE ENERI>V SURCHARGE <br />ICE BY <br />PUBLIC WOFiKS <br />TOTAL <br />PROPERTI'L��NELOCFTONSANDNREIATEDE SEMF.NTISINGALI. <br />