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m. enrpr..n <br />c�n oc <br />everett <br />BUILDING DEPARTh1ENT <br />259-8810 <br />t��!�,:'� _ -� <br />�r;�PLICATIOf� FOF►-� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />everen <br />� <br />❑ DEMOLITION �COMBINATION T6[DUILDING 1�MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MeILA0DRE55 CIIY ZIP P��ONE <br />i�A1CntOfJ 9F /�SSDc 47,.25 :�(CD �11F N� i�"SDD StATt E t�IIS S�%`2D$S <br />♦RLNIIECTORpESiGNER MnIL�00RE55 CIfY I�P P��ONE <br />6PA2ra+iie�Ts /loon LAicG C�7� wA�l nIL' s�AT'rr.� �l�S 3�7-3loDo <br />GfN[N�ICONIF�CION M�ILA00(1[SS'�/ �— p11Y IIP �I�pNE �ICENSE� <br />h/11 P nA/ i niP 1!_ii ) �i.�l= i1..R C)l Cnlwi_l� n..� �1 LJ6 Z4n l�Q� ��ir/ /F�IGDN <br />•DpRESS <br />PIIONE <br />PIUMBINGCONiR�CiOR Me1LP�DRE55 CIiY ZIP � PIIONE LICEN54_a .,. <br />d/M��9 <br />M n�i--lbtYG' Lt`k'"'(3V' <br />CL�55 0� WOPK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ qEPAIR ❑ OEMOLITION ❑ WOODS70VE/FRPL.INSERT ❑ BUILDING RELOCAIION <br />GL <br />a ov apo <br />�os---- <br />PLUMBING <br />NoT— <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORV�WASM BASIN� <br />SHOWER <br />KITCHEN SINK d DISP. <br />FLOOA DRAIN ' <br />BACKFLOW PBEVENTERS <br />FOOF ORAINS — RAINLEAOERS <br />SINK ISERVICE — BAP. ETC.1 <br />SUBTOTAL f <br />PEqMIT f <br />TOTAL FEE S <br />rnun�5e�enC�qE�R5`EI,BACK <br />. .y���—_' .� /l� � <br />lISEtONE `/ LJtAPEA <br />GT <br />TYPE OF CONST OGCUPAHGY G <br />; Z�F,P f3-2 <br />, •Si2EOFBL00. NOOFSTORIE <br />:anaruncr^, or <br />� � 1' <br />PLRNS CHEGNED BY <br />� <br />/ � <br />pYES <br />COP�ES� <br />FEE <br />� <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMF TO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINAiJCES GOVERNING TIiISTYPE <br />OF WORK WILL BE COMPLETED Wl�;H WHETHEFlSPECIFIED HERE- <br />�N OR NOT. THE GRANTING OFA PER�41T DOES NOT PpESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY O'HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUREOFCONfRACTOPORAUTHORIZEOFGENT OATE���(` fr� <br />X � <br />MECHANICAL <br />TYPE OF EOU�PMEIiT <br />A/C — A/HNDLG UNITS — H.P. <br />REFflIGERATION UNITS — H.P. EA. <br />BOIlEHS — B.T.U./H P. <br />GPS FIRED A.C. UNITS — B.T.U. <br />FORCED AIP SVSTEMS — B.T.U. M EA, <br />WALLHEATEFS—B.T.U. M <br />UNITt1E4TER5—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTNESOR'/ERS <br />VENTILATION FAN <br />HANGEHOOD <br />WATER HEATER '� <br />wOODS70VE <br />METAL FIPEPLACE 8 CHIMNEV <br />FIREPtACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />PIAN CMECI( UMBER FEE <br />�%1963�� ��i 3 <br />BU�LDING <br />PIUMBING <br />MECHANICAI. <br />OTHER ��jaN I,�M.1� <br />STATE BUILOING SURCHARG <br />STATEENERGVSURCHAFGE <br />PUBLIC WORKS <br />T0T4L <br />S <br />� <br />FEE <br />REC IPTNO. <br />S3� � <br />PROPERTY JWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PFiOPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />