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!N Enrprnn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />,: ;,.,, : <br />��PPLICATIQiN FO''F.:' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />0 DEMOLITION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />�R$V��'���� everen <br />� O <br />❑ PLUMBING ❑ SIGN <br />IMi�c LJfk <br />Iv���un 6o.+w�avi �rv�v�c1� �w.��p 2.aoo It�-�fi. �4vc hI $alltt�(K. I.�FF `18W�i' '�. 45433�� <br />GENEMLCONTHACION `.:. •�± �iNooaEfDiZb {'�IG1l]a1�, f'i�'N �Tc1GWlT �E��3 oNE3G73&b� LICENSE• <br />1 �w a..1 litec.�v� COv.S�/IJ� <br />MECNRNICRLCONTPACiOfl � AUILFDORESS ��n' ZiP PHONE LICENSE• <br />.. - � _ . � � . . � � . . . . r� � . ir-�" � . w ie � /f � ♦ . <br />m <br />� <br />i OF WORK <br />�7EW ❑ AOOITION ❑ ALTERAI�ION ❑ PEPAIR ❑ DEMOLI710N <br />�oi—e�ocK— <br />PLUMBING <br />WATEF CLOSET �TOILET <br />BATHTUB <br />LAVATORV�WASHBASIN <br />SMOWER <br />KITCHEN SINN L DISP. <br />�ISHWASHER <br />LAUNDRYTRAV � � <br />URINAL <br />raoHrseiencn <br />O <br />USEZONE <br />e�� <br />- RAINLEADERS <br />. -BAR. E'fC.) <br />SUBTOTAL <br />PERMIT <br />TOTALFEF <br />REAq SETBACN <br />a <br />LUIRqEN <br />OCCUP�NCYGflO <br />�'L <br />N0. OF STORIE$ <br />� <br />��� <br />�'Z-�; � Nt�.d�.� <br />u� s� <br />� <br />� <br />YnUnG LICENSE � <br />RPL.INSERT ❑ BUILDItJG RELOCATION <br />� /^ �7z9•3� <br />�—� � <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EkAMINED THI$ AP• <br />PLICATIONAND KNOW THE SAMETO BETRUEAND CORREC7'. ALL <br />AlTAC11F0URCOPlE5) pqOVISI0N50FLAW5ANDORDINANCESGOVERNIN3THISTYPE <br />OF WORK WILL �E COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT, THE GRANTING OF A PERMITDOES 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 />SIGNATUflEOFCONTRACTOROFAUTHOF712EDAGENT DATE ' <br />i� _� . _ � � . /1 _ Q. �w 1 .a�.r <br />FEE <br />0 <br />NT9tE <br />ONO <br />0 <br />R-t-3y To #3f <br />; ,� r''�, T <br />NO <br />MECHANICAL <br />A/C — A/HNDLG UNITS — H.P. <br />REPRIGERATION UNITS—H.P. EA.' <br />BOILERS — B.T.U./H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCEDAIRSYSTEMS—B.T.U. MEA. <br />WALLHEATERS—B.T.U. M <br />UNITHEATEFS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHESDflVERS <br />VENTILATION FAN <br />WOODSTOVE ` <br />METAL FIREPIACE 8 LHIMNEV <br />FIREPLACE INSERT <br />HEATPUMP <br />PIAN CHECK nUMBER <br />SUBTOTAL <br />PERGIi <br />TOTALFEE <br />IFEE� ��� <br />H <br />' FEES ' � <br />uNirs BUILDING 3� <br />PLUMBING �I <br />MECHANICAL <br />��_ <br />OTHER <br />STATE BUILDING SUFCHARGE <br />STATEENERGYSURCHARGE <br />ICE OY <br />PUBLIC WORKS <br />TOTAL <br />PECEIPT NO. <br />�D6t� <br />FEE <br />PROPERTY OW NERS AFE RESPONSIBLE FOR DETERMINING ALL <br />PROPEFN LINE LOCATIONSAND RELATED EASEMENTS. <br />