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�PPLICATION F(JY♦ everetl <br /> fhe Ers�p�nn C O N ST R U C T i G► N � <br /> Cltt OF <br /> everett PERMIT <br /> TO BE COM�LtTEO IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. � <br /> 259-8745 /� COMBINATION ��c9UILDING ❑ MECHANICNL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILA�DRESS GIIY ZIP PHONE <br /> T- t3 S-1-o�l��N P� � � �� y� E�+ �� �� r 3s9 - 22.9.i <br /> � � <br /> �RCI:IIECTOROESIGNEP MRIIAD�RE55 CITY ZIP PMONE <br /> S��-�' — <br /> GENEN�LCONiRACiOR Mr11LApONE55 CILV ZIP PHONE UCEtlSE� <br /> MECIIANIC�LCONiR�GtOA MRIIRODRE55 GITY 2iP PIIONE UCENSE• <br /> �t•,,, '� � • �.�.,-. � s Ev�� — <br /> PLUMBINGGOMRACLO� MpILA00fiE55 CITY ZIP PHONE �CENSE <br /> LLA55 OF W�lil( <br /> ❑ NEW C� ADDITION ❑ ALiERATION �REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VAWAiIONOFWORN�W iQFAIAIERIqLSPLUSUBORI , �c QQd <br /> R� � .,,..�\E� �n � T c� : ��\ c��"o`�� �-�== <br /> OESL�IOE WORK i \ <br /> ` \ y J <br /> j� -C S 1 <br /> USEOF UILOINO <br /> I HEAEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW TIiE SAME TO BE TRUE AND CORRECT.ALL <br /> LEOALOESC(IIPTIONOFPROPEHiY15NOlYN9ElOWORr1TTACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNING?liISTYPE <br /> `�(_ " OFWOFKWILLBECOMPLETEDWITHWHEiHERSPECIFIEDl1ERE• <br /> �or�y�Z'eioc�yZ�ov Ev�"�� �'�`� 10� INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> /acc� t-��--�� t. -t�� Q` "� ���` R Eo E GIVE AUTHORITY TO VIOIATE OR CANCEL THE PFOVISIONS OF <br /> � F; ���.��.' � � \ �., - o � P1u� ANYOThIERSTATEORLOCALLAWFEGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUC710N. <br /> � p�� S� �E W t„� � U� �E n""��� � SIGNATURE OF CONTRqCTOR OR AUTHOPIZED AGEN� DAIE <br /> r k ��.� Co'.., �..�� � ^` . <br /> s 1-.�_ �, �- v� .,. � � � X�� � 3 z� q �- <br /> PROJECT AODNE55 APPLICANtS CITY 9USINESS LICENSE NO. <br /> G �o �e — <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. 7YPE OF EOUIPMENT FEE _ <br /> WATER CLOSET�TOILEn AIR COND. UNITS-H.P.EA. <br /> BATIiTUB REFRIGERA110N UNITS-H.P. EA <br /> LAVATORVIH'ASH BASIN) BOILERS-H.P.EA. _— <br /> SHOWER GAS FIRED AG UNITS-TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCED AIR SY51[MS-B.T.U. M EA. _ <br /> DISHWASNER WALLHEATERS-B.T.U. M <br /> LAUNDRYTRAY UNITHEITERS-B.T.U. M _ <br /> CLUTHES WASHER EVAPORATIVECOOLERS _ _ <br /> WATER HEATER CLOTHES DfiYE(75 <br /> URINAI VENiILATION FAN � <br /> DFINKING FOUN7AIN RANGE NOO� __ <br /> FLOOF DRAIN AIR HANDLING UNIT- QF.M. _ _ <br /> VAGUUM BREAKERS STOVE — <br /> FOQF DRAINS-RAINLEADERS METAL FIREPLACE 8 CHIh1NEV <br /> SINK SERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT — <br /> SUBTOTAL <br /> SLBTOTAL 5 C <br /> PERMIT 5 PEflMIT S <br /> TOTAL FE13 S TOTAL FEE S <br /> THIS PORTION TO [3E COMPLE7ED SY BUILDING DEPT. PERSONNE� <br /> FRONiSEiBACK RE4PSE7BACN SIpESETBr1CK PLANCHECKNUTA�ER PLANCNECHfFE <br /> FEE RECEIPL N0. <br /> USE20NE LOIAOER VqCANi517E FEES VALUATION FEE <br /> OYES ONO <br /> TYPEOfCONST. OCCOPPNCVGROUP NOAFOWELLINGUNIT3 ^�` <br /> BUILDING E / ( l7 l' <br /> SIEEOFB�OG. ��O.OFSTORIES MAXOLC.lOA� <br /> PLUMBING <br /> MECHANICAL <br /> riRE SPRINKLERS REOUIRED O YES ❑ NO <br /> OTHER <br /> PENALiY <br /> APFUWiIONAGC.BY PLANSCHECNEOBY pPPN.FORI5511�NLEDY �� <br /> TOTAL � � <br /> SI� <br />