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i,�PLICATION FO�. everott <br />`".E",°"'" CONSTRUCTION 0 <br />cin oF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATIOM �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW��ER MqILRDDFE55 LITY ZI� PNONE <br />• �u . _ _ _ � �. _ _.• �r�I <br />ONONE - 110EN5E+ <br />LILENSE � <br />PLlW91NGCON1PAGiOF MAILA�DRE55 CITY ZIP PIIONE UCENSE• <br />❑"NEWV^ � AOOI710N ❑ ALTERATION ❑ REPAIR ❑ O�MOLITION ❑ �'�'OODSTOVE/FRPL.INSERT <br />�e� uannu nv WORK�f.OST OF MAiERIALS PLUS LRBORI <br />pESCRIBE ORK <br />LO1_ <br />PFOJEGTAO�Rt�] �F��n R�� (j <br />�y1W�f1G G,� <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />WATER LLOSET �TOILET) <br />gATF1TUB <br />I.AVATORY �WASH BASINI <br />SHOWER <br />NITCMEN SINK 6 OISP. <br />OISIiWASNEP <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAI <br />BACKFIOW PREVENTERS <br />ROOF DRAINS — RAINlEA0ER5 <br />SINK �SERVICE — BAP. ETC.� <br />� � <br />r _ _—_ <br />�ucrvrsere<cn <br />USf LONE <br />iYVE Of COrvSi <br />� <br />SiiL OF BL�G <br />G�9_ 9� � S <br />SUlTOTAL <br />PERMIT <br />TOTAL FEE <br />R SETBACK <br />f <br />�� <br />❑ BUILDING RELOCATION <br />1 HEREBY CERTIFY THAT � HAVE FEAD AND EXAMIfJED THIS AP- <br />PLICATIO�J AND KNOW THE SAME TO BETRUE AND CORRECT. ALL <br />PROVISIOIvS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMRNCE OF CONSTRUCTION. . <br />SIGNATUFE OF CONTRqCTGR OF Al1THORIZED AGENT DATE <br />X •l1'�/�6E.�elllA�' 3�3�� <br />NO <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPME <br />A/C -• A/HN�LG UNITS — H.P. <br />REFNIGERATION UNITS — M P. EA. <br />BOILER$ — B.T.U./N.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SVSTCMS — B T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATENS — B.T.U. <br />EVAPOf7ATIVE COOLERS <br />CLOTMES�RVERS <br />VENTIiAT10N FAN <br />HANGEHO00 <br />WATER HEATER <br />r-� <br />� 1AETAL FIREPLACE 8 CHIMNEV <br />FIHEPIACE INSERT <br />HEATPUMP <br />: GAS PIPING <br />PI.AN CHECK NUMBER <br />�U �/:JCV/4. <br />M <br />M <br />M <br />SUBTO7AL <br />P[RWT s' <br />TOTALFEE f <br />IFEE O � RECEIPT YO. <br />13�1 �17Cn< <br />BUILDING <br />PWMBING _ <br />MECHANICAL <br />O7HER <br />STATE BUILDING SURCHARGi <br />STATEENERGYSURCHARGE <br />PUBLIC WOFKS <br />TOTAI. <br />PROPERTY OWNERS ARE RESFONSIBLE F(JR OE7EFiMINING ALL <br />PROPERTY LINE LOCATIONS FND RELATEU EASEMENTS. <br />