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;;�PPLICATIOPY FOF� �veren <br /> �^.Ewro�N° CONSTRUCTION e . <br /> un oF <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259-8810 <br /> 0 SIGN <br /> ❑ DEMOL1710N O COMBINATION �BUILDING � MECHANICAL ❑ PLUM8ING <br /> ��n, Z�p PNONE ` <br /> OWNER MRIL�DDRE55 I �� J /�n ,� —7_ 1 �)�D <br /> � hLU�i�76�U ��[1:��: N7'��CJ� /�U `Y <br /> `�T, Z p PHONE <br /> �� �"` 6�� � � LnD�RESS <br /> AqGMITEGT ON OESiGNER <br /> Mi L��, z�p �NONE LICENSE• <br /> GENECR�LCONLR�CIOR <br /> M�IL��ORESS <br /> p��MG ��ry ilP PNONE LIGENSE• <br /> MEGH�NiULCONTPALTOfl <br /> M�IL A�ORESS <br /> Citt 2�F PHONE 4CENSE� <br /> VLUMBI�Ny y M�ILAODAE55 <br /> T/ <br /> CL�SS OF WOAK <br /> � NEW ❑ ADDI710N ❑ AL ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br /> WLWT�ONOFWORKIGOOFMATENUlSP SU�A� �r <br /> OF.SCRIBEWOHN zX � � �n�,LS t`c�u�e �� �� �� <br /> �`.� � � - �n l . t�wX <br /> USEOFff ILDINO � � I HEREBY CERT�FY THAT I HAVE READ AN EXAMINED HIS AP• <br /> �QR�� PIICATION AND KNOW THE SAMETO BETRUE ANDCORFECT.ALl <br /> t.EOAl0E5GAli`TIONOFPROPERiVISHOWNBE�OWORpiTRCMFOUACOFIE51 '/ PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � r- . ,�,�{— OF WORK WILL BE COMPLETED WITH WHETHEF SPECIfIED HERE• <br /> 1�--�'(�,a��pF rC�� G�I— ��LZ� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> �o� G�VE AUTHORITY TO VIOLRTE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> . OR THE PERFORMANCE OF CONSTRUCTION. � <br /> SIGNAil1FE OF CONIRn O OR AUTHORIZEO AGENT DATE <br /> � Q �_�. <br /> � �p �ry , GITY 1 E55 L�LENSE NO <br /> �qOJELTADORESS <br /> Z��l �M����� MECFIANICAL <br /> PLUMBING 7YPE OF E�UIPMENT FEE <br /> TYPE OF FI%TURE OR ITEM FEE N�• <br /> NO. q/C—A�HNOLG U41T5—H,P� <br /> W�'(ER CLOSE7�TOILET� qEFNIGERATION UNITS—M.P.EA. <br /> BATHTUB BOILERS—B.T.U./H.P. <br /> �qVATCRV(WASH BASIN� GAS FIPED A,C.UNITS—B.T.U. <br /> SMOWER FOflCEOAIRSYSTEM�—B.T.U. M�� <br /> NITCHENS�NK6OISP. WqLLMEATEPS—B.T.U. M <br /> O�SHWASHER UNITHEATERS—B.T.U. M � <br /> ' LAUNORYTFAY EVAPORATIVECOOLERS <br /> CLOTHES WASMER CLOTHES OFYEPS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN qqNGE Ii00D <br /> FLOOR URAIN �+/qTER HEATER <br /> BACNFLOW PREVENTERS WOOD STOVE <br /> qOOF OPAINS—AAI�LEAOERS ME7q�FIREPLACE d CHIMNEV <br /> SINK�SERVICE—BAR.ETC.) FIREPLACE INSERT <br /> HEATPUMP � <br /> GAS PIPING <br /> E%HAUSTFAN � <br /> SUBTOTAL <br /> SUBTOTAL f <br /> P[RMIT <br /> PENMIT s <br /> TOTAL FEE <br /> TOTAL FEE f Q .�.� pECEIPT NO. <br /> PLAN CME K NUMBERI FEE �� � ��^,�/� <br /> � SIOE SETBACK N�Sr �� ��� � /I/� U v I <br /> FRONiSETBACNr RE�H$ET�CN � �� <br /> 0 <br /> S d- �o �V <br /> FEES VALUATION FEE <br /> USE ZONE LOTAPEA � ypCRNT S TE � ^O <br /> ��7 OYES O (�/O _ <br /> �� OV� BUILDING <br /> NO.OF UWELLING UNITS <br /> TVPE OF GO T. OCCUPANGY GROUP � PLUMBING <br /> . �'/� �'� <br /> 512E OF BLW NO-0F STORIES MAX'���'�o:o MECHANICAL . <br /> � 7� Jt' � `"� 5 <br /> O7HER <br /> FIRE SPRINKLERS RE�UIFiED ❑YES NO STATE BU LDING SURCHARGE <br /> S7ATEENERGYSURCHARGE � � <br /> pPPR FOPISSURNCEBY PUBLIGWORKS _��- <br /> ♦PPUGAiIONPGC B� PLANSCMECREOBV . <br /> � � `^�� TOTAL <br /> �V .� . ar..� <br /> PROPERTYIOINEL CATONSA�NRELAEEDEASEMENT'gINGALL <br /> .^� .'��;j�� �;��,.-..i: �,� :....'f� . -. :'' , - <br /> _ : <br /> 1''. <br /> ..... ,.:: '6 <br /> T: .�..6. a� <br />