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l>•.IPPLIC�I,TION FOIaJ cvereH <br /> '".E",°'"° CONSTRUCTION 0 <br /> cin oa <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 2�9•8810 <br /> 1 <br /> O DEMOLITION ❑ CGIMBINATION O BUILDING �MECHANICAL �PLUMBING � SIGN <br /> ��r�[� �/l/ �r/_�h'��.��`/�G /eJ��/ L�(����Y_J-�¢�.L/ �r��� � L:Y�,��^ �`J�-�('^OCi,��. <br /> �RCNIfEG10 �ES�ONEP M�ILPODRESS C�iV ZI� pHONi ,/ <br /> GlNER�L LONIN�CfOA MML AOORE55 CIIY ZiP PI�ON: LiCENSE� <br /> � <br /> C���L.co� YI '/l.�i lC-��V �'`�`-��� / (!� ( / ��//�/� ���Vr_ L( �1��� �7 ��/v�'�- iccn«. <br /> P�UG911la�ON�R4LlOA MRiI.aDONE55 CIiV ZIP OqC � � IILE�15E• <br /> ���r� �:��y�l�Sx/� ��c,----- <br /> CL<55 OP VlOPr • <br /> ❑ NEW �ADDIiION ❑ ALTERATION ❑ REPAIF ❑ DEMOLtTION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LU ONOFWORK�COSiOF1AAlEPUL5PW5lABOF1 <br /> ����- <br /> OE/SCRi/BEWOAn/C � � ���i L'L.��IJ.C-���, / ���� IZJ J� ���� �-���/L.�- <br /> ` ,`T��� � � <br /> usE or euMoi�. 1 IiERC-BY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br /> '1 f PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.�LL <br /> LCOA�pESLPIP110N0�>AOPE�IYISNOWHOELOWORRII�CIIFOUIICOPIE91 PROVISIONSOFLAWSANDORDIIJANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BECOMPLETED WITH WHETHERSPECfFIED HERE- <br /> �o�—eioc�_ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOPIS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> DR THE PERFORMANCE UF CONSTRUCTION. . <br /> SIONFTU EOfCO��iFACTONORAUTHOfiI EOAGEN7 �rl1E <br /> X C��h-���t-�.�t��-���r���/- J <br /> , pp��ip p 5� ��� ^���� �, /� APPLICRNi�IYlU`S��C�SENO <br /> 0 E C�' � <br /> !A� � �j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER ClOSET�TOILET� NC—A/HNDLG UNITS—HP. <br /> BATNTU� REFRIGERATION UNITS—H P.EA. <br /> LAVATORY(WASH BASIN� BOILERS—B.T U./HP. <br /> SHOWER GA5 FIRED A.C.UNITS—B.T.U. <br /> NITCHEN SINN 8 DISP. FORCED AIFl$YSTEMS—B T.U. IA EA. <br /> DISMWASNEN WAIINEATE�S—A.t.U. M <br /> LAUNDAY TRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASMER EVAPOf1ATIVE COOLERS <br /> UNINAL CLOTHESORYERS <br /> DRINKING FOUNTAIN VENTIIATION iAN <br /> FLOOR ORAIN AANGE HOOD <br /> BACKFLOW PFEVENTcRS WATER HEATER <br /> ROOF DRAINS—RAINLEAOERS WOOD STOVE <br /> SINK�SENVICE—BAR.ETC.) METAL FIREPLACE 8 CHIMNE� <br /> !t • ��L� �( //_����T,:r_ FIREPUICEINSEfiT <br /> i l� T <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUB T0T111 f SUB TOTAL <br /> PERMIT S PERM�T <br /> TOTAI FEE f TOTAL FEE <br /> �nor�i SEIOnCrc REAR SE19nCK SIOE SETBACK P�AN CMECK NUMBEA FEE AECEIPT NO. <br /> ust tone ioi nnea yqCRNi SIIE FEES VALUATION FEE <br /> OYES ONO <br /> 9UILotNG g <br /> t'r0(pif.0�lSt OCCIIOa�JpVGf10UP NOOFpWELLINGUNIiS <br /> � ' PLUMBING <br /> S�ZE C�9lOG NO OF StORIES MA%.00C.LOAD <br /> MECHANICAL <br /> OTHER <br /> FIfiE SPRINKLERS flEOUIRED ❑ VES ❑ NO STATE BUILDING SURCHARGE <br /> STA',E ENERGY SURCHAfiGE <br /> 4YFUC�il0�J4CC pv PLANSCIIECNEDBY APPR.FORISSUANCEBV <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTV OWNERS Af7E RESPONSIBIE FOt7 DE7ERMINING ALL <br /> PROPERTY LINE LOCATIONS ANO RELA'iED EASEMENiS. <br />