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m. ev.rpr«n <br />CIIY OF <br />everett <br />BUILDING DEPARTMENT <br />259-BB10 <br />i1'PPLICA710f�i FO�';':� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everetl <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �LUMBING ❑ SIGN <br />OWNEf1 M�IL�DORESS G�1Y Z�P PHONE <br />T• �� / —ri . �n�i/ /" ''�/�� C'. .t.L in.n...-� ? C��r� c'�/ l <br />GENER�IGONtNACtOR M�IUOOHE55 CIIY ZIP VNONE LICENSE• <br />�nEG1UNif.eL CONTN�CIOfl M�IL�ODHE55 CIiY ZiP PNONE LICENSE • <br />PLUMB�NOCONif1AGfON M�ILRO�RE55 CIIY 21P PNONE LICENSE� <br />u' � v N e Vr' <br />CL�SS 0� k'ORN <br />❑ NEW ❑ AODITION � ALTERAT�ON ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />W We�iON Oi WORN �W51 OL M�iERUL51'WS IABORI <br />LEOAL DESCRIPIION JF <br />wr— <br />�iX'I�u-KS i .v l i`e, <br />.ACD'iCtl�(./'(� /C/O M f� <br />n - <br />3ncvwrv �SHowu �E�Ow ON FTTACH FOUR COP <br />iOJECi�U0RE55 <br />�5"ga� �o� «�: f��� � <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER ClOSET �TOILET) <br />BATHTUB <br />UVATORY (WASN BASIN� <br />SHOWER <br />KITCHEN SINK S DISP. _ _ _ _ <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />ORINHING FOUNTAIN <br />FLOOH ORAIN ' <br />BACKFIOW PiiEVENTERS <br />ROOF DRAINS — RAINLEAOERS <br />SINK �SERVICE — BAR. ETC.) <br />r aor+r se ioecK� <br />wr <br />SUBTOTAL s <br />PERMIT S <br />TUTALFEE f <br />VAC�NT SItE <br />OYES ONO <br />IOHnL� IPUNSCHECItEOBY I�PPII.FC8155U�NCEBY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETEU WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PAESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />A�JY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIUC2 <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUPEOFCONTRACTOROFAUTHOflIZEDAGENT �ATE <br />� � � <br />CITY <br />MECHANICAL <br />NO. TYPE OF EOUIPI <br />A/C — A/HNDLG UNITS — N.P. <br />REFRIGERATION UNITS — H.P. I <br />801LEP5 — B.T.U.: H.P. <br />GAS FIRED A�C. UNITS — B.T,U. <br />FOflCED AIR SYSTEMS — B.T.U. <br />WALL HEATEflS — B.T.U. <br />UNIT HEATEFS — B.T.U. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATEq HEATEF <br />WOODSTOVE ` <br />METAL FIREPLACE d CHIMNE'/ <br />FiREPtACE INSERT <br />HEATPUMP <br />OAS PIPINO <br />E%HAUSTFAN <br />SUBTOTAl <br />PERMIi <br />TOTALFEE <br />PLAN CHECK NUMBER � FEE <br />BUILDING 5 <br />PLUTABING <br />MECHAN�CAL <br />3- /7 <br />FGC <br />RECEIPT NO. <br />OTHER <br />STATE BUILDING SURCHARGE <br />STA7EENERGVSURCHnRGE <br />PUBLIC WORKS <br />TOTAL � <br />PROPERiY OWNER9 ARE RESPONSIBLE FOR OETEPMINING ALL <br />PROPERTV LINE LOCATIONSAND RELATED EASEMENTS. <br />