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�;i:�r � � ;�) <br />,,PPLICATION FO'►: <br />,".E".°`"° CONSTRUCTION <br />GITY OF <br />everett PE RM IT <br />BUILDING DE?ARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILOING O MECHANICA� <br />� PLUMBING <br />evcretl <br />� <br />❑ SIGN <br />'(J.�...r � � n�/�� �•o.n,n �.o � l0 6 q — � eP rn o n� d-s ' <br />GE ERAI C TFRCIOF M�IL R�OPE55 CItY LIP PHONE LICENSE • <br />MEGM�NICALGONiR�GTOq M�IL��DHE55 GIIY ZIP PIIONE LICENSE� <br />1 <br />❑ NEW � ADDITION ❑ ALTEFATION ❑ REPAIfl ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V��UATiON OF WOPH �COST OF MATEflIqLS PlUS LRBORI <br />A.,. T_!, 2.a.4,{+ A.c.ai CvA1• ��f.ow cQn.ai.:.. fl5ee- <br />OESGRiBE WONIt <br />'� -�•i. �,u.ut 'v�a.�4 uuy <br />PLUMBING <br />fRONi <br />TYPE OF FII(TUHE OR ITEM <br />WATER CLOSET �TOILET� <br />BATHTUB <br />IAVATORY�WASM BASIN� <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />LLOTHES WASHER <br />UiiINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN - <br />ROOF ORAINS —RAINLEADERS <br />SINK �SERVICE — BAR. ETC.) <br />-� t tv-(�- <br />SUBTOTAL f <br />PEPMIT f <br />TOTALfEE S <br />RERNSETBRCK SIOE <br />LOTAPEA <br />OCGUPANGVGNOUP <br />NO OF STOPoES <br />9ED ❑ YES ❑ I <br />PLRNS CNECNED BY <br />VAC�NT SITE <br />OYES ONO <br />NO.OF DWELLING UNITS <br />M�:t OCQ LORO <br />FORISSURNCE BY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICRTIONAND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES30VERNINGTHISTYPC <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OF NOT. THE GRANTING OF A PERMIT DOES NOT. PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUREOFCONiRACTOFORAUTMORIZE�AGENT DATE <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />A/C — A/HNOLG UN7TS — H.P. <br />REFRIGERATION UNITS — M.P. EA. <br />BOILEFS — B.T.U./H.P. <br />GAS FIPEO A.C. UNITS — B.T.U. <br />fORCED AIR SYSTEMS — B.T.U. M EA. <br />WALLHEATEHS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVA�ORATIVE COOLERS <br />CIOTHESDRVEPS <br />VENTILATION FAN <br />HANGEHOOD � <br />WATER MEATER <br />WOODSTOVE <br />�1ETAL FIREPLACE d CNIMNEV <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PEPMIT <br />TOTALFEE <br />PLANCHECKNUMBEH FEE <br />FEES VALL <br />BUIL�INCa $ <br />FLUMBING <br />N.ECHANICAL <br />OTHER <br />STATE BUILDING SURCHARG <br />STATEENERGYSUFiCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />HFCEIPT NO. <br />PFiOPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />