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� -� ��R -�j� <br /> `�'���PPLICATION FO�:'�' <br /> y ,,.�� <br /> j ' m.ernpr.�n . . everetl <br /> ��n�F CONSTRUCTION e <br /> everett PERMlT <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> � ❑ DEMOLITION ❑ COM8INATION ❑ BUILDING � ECHANICAL ❑ PLUMBING ❑ SIGN <br /> ; Dh.n �rdra /�l�Do�l7ll.CC!"7rL �ICY.�u./ .XJLCJ� PIIONE � _ <br /> � AflLHItECfORDlSIGNtR MqILADORE55 CITI LP PNONE <br /> 1 - <br /> GfNEAA�GONINRCIOR Mall ApOf1E55 CIIY ZIP vNONE LICENSE• <br /> � <br /> ; jA$.'N�I��ONIRPC �� �� n�p/AJ /'Si��nta�D Au� C�VJ�J/� Zi!//LJ� _.'.��IOaJ �`�� {�I V'�f4 <br /> 1/a �i � <br /> j P UMBiNOCO AAGiOR MRIL AODFE55 CIT1' ZII' ���JNE LiC[f15E• <br /> ! <br /> 1 _ <br /> j CUSSOf WORN <br /> � ❑ NEW ❑ ADDITION L�ALTERATION ❑ REPAItI ❑ DEI+IOLITION ❑ WOOOSTOVE/FRPL.INSEf7T ❑ BUILbING RELOCFTIO�I <br /> j V 1PilONOFWORF�CQ�j[OFMRiER LSPWSLRBOHI <br /> I 2/q�,o� <br /> � o IBE WOAN � <br /> � � � D.( ,�1.Ihn4 �� .S �'D�� <br /> { USE Qf-BU� I G <br /> G " i HERGBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> a � <br /> � �� pLICATIONANDKNOWTHESAMETOBETRUFqNDCORRECT.ALL <br /> LEOALUESCRiFi�ONOFPPOPERTY�SHOWNBELOWOPAITAC11FOlIHCOPIE51 pROVISIONSOFLAWSANDORDINANCESGOVE:RNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHEHSPECIPIED HERE- <br /> � �oi—e�oc�_oF_ IN OR NOT.THE GPANTING OF A PERMIT DOES VOT PNi55UME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or' <br /> i ANY OTHER STATE OR LOCAL LAW REGULATING CONS�f RUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> � SIGNATURE OF CONTRACTOR OR AUiHORIZEO ACENT �4TE <br /> i y <br /> � ^ , ✓�) �'� <br /> IPROJECTRDURE55 APPIICFNiS IiVBU51NES5LICEN5EN0 <br /> � lD/� �vm �d� �.u-� <br /> � PLUMBING MECNANICAL <br /> '� NO. TYPE OF FI%TURE.7R ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> iWIITERCLOSET�TOILET� A/C—A/liNOLGUNITS—M.P. <br /> I BATHTUB REFRIGEPATIONUNITS—HP.EA. <br /> 1 LAVATORVI�'�'ASHBASIN� BOILERS—B.T.U./H.P. _ <br /> � SHOWER GASFIREDA�C.UNITS—B.T.U. <br /> � KITCHEN S�NK d DISP. FORCED AIf1 SYSTEMS—B T.U. M EA. <br /> OISMWASMER WALLMEAIERS—B.T.U. M <br /> � ' UUNDHYTRAV UNITHEATERS—O.T.U. M <br /> � CLOTHESWASHER EVAPORATWECOOLERS <br /> � URINAL � CI.OTHESDRVERS <br /> I <br /> � DRINNING FOUNTAIN VENTILATI(1N FAN <br /> ;�. FIOOR nRAIN ' R�NGE HOOD <br /> � BACKFLOWPREVENTERS 'NATERHEATEii '� <br /> jROOF DRAINS—RAINLEAOERS WOOD STOVE <br /> �� SINK�SERVICE—BAH.ETL.) MEfAL FIREPIACE 6 CHIMNEY � <br /> � FIREPLACE INSERT <br /> � HEAT PUMP <br /> GAS PIPING <br /> � EXHAUSTFAN <br /> � SUtlTOTAL f SUBTOTAL <br /> t <br /> � PEpMIT S PERMIT <br /> � TOTAIFEE S TOTALFEE � <br /> i <br /> 1 rPONT SEm�Lrc RE�A SEIBACH SIOE SEIBRCN PLANCHECN NUMBER FEE RECEIPT NO. <br /> 1 <br /> y usezorvc LOTAPEA. yqCANTSRE FEES VAIUATION FEE <br /> � � ares oruo � <br /> ) TYPEOFCONST. OCCUPRNGYGflOUP NOAFOWFLLIN.UNITS BUILDING S <br /> I <br /> PLUMBING <br /> S12E 0�BlDO NO OF$10RI[9 MR% OCC lOAO <br /> � MECHANICAL <br /> OTNER <br /> i FIRE SPRINKLERS REDUIRED ❑ YES ❑ NO STATE 13UIL�ING SURCHARGE <br /> � STATEENEFGYSUFCHARGE <br /> AVPLICAiION ACC 0� PLP.NS CMEGNED BY APPR.(OR ISSUANGE DY <br /> PUBLIC\'JORKS <br /> � TOTAL <br /> PROPF.FTY OWNERS�F7E RESPONSIBLE FOR DET[RMINING ALL <br /> � PROPERN LINE LOCATIONS AND RELATED EASEMENTS. <br /> { <br />