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�`"�pPLICATiON FOti:� <br />�I� jNEorymn ��CO�NSTRUCTION <br />.r y cin <br />`'� �everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8810 <br />❑ COMBINATION ❑ BUILDING � MECHANICAL <br />, G DEMOLITION ��n. Z„ <br />MAIL��'Mc�a I � <br />'LUMBINOGONIP�GTOH �^`` L � � t � <br />C Glq; � c.vr �� % ' � � <br />;L�SS OF WOAK <br />❑ NEW ❑ ADDITION ❑ A�TERATION ❑ REPAIR <br />T <br />PLUMBING <br />NO. <br />WATER <br />/✓-� � J/ � <br />ITEM <br />NITCHEN SINK 8 �ISP. <br />OISMWASHER <br />' UUNOPV TRl1� <br />CLOTHES WASHER <br />UN�NAI <br />O��NNING FOUNTAIN <br />FLOOR ONAIN � <br />tlACKFLOW PQEVENTERS <br />ROOF ORAINS — AM� <br />S�NN �Sc . ���%E—BAR. E�C.1 <br />1 V'. � ` � � <br />SU9TOTAL <br />PERMIT <br />TOTALfEE <br />fPONT5E18�LM AE�A SETOAGn <br />B� <br />er <br />FEE <br />���,�n <br />e. <br />❑ PLUMBING ❑ SIGN <br />vHor+e • <br />�"l�'�A-a't111' F�.c�l�/ <br />P110NE <br />.,.....,c �ICENSE • <br />Gltt ZiP FIIONZ3Z,�f61 UCENS[• <br />�Cltt ZiP P��ONE LiCEMSEp• <br />f i�1�, '� �' o o l w M� l,S �'!J K/� <br />1� <br />�EMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATIOIJ <br />I HEREBY CERTIFY THA'f I HAVE READ AND ExAMINED THfS AP• <br />PLICATION AND KNOW THE 5AMET0 BETRUE hNDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO <br />ANYOTHERST'ATEOR OCALLOAWREGULATINGCONSTR�UCTION <br />OR THE PEFFORMANCE OF CONSTRUCTION. � <br />SIGNATORE OF CONTRnCTCR OR AUTNORIZED AGEi�T OAT��� /�� <br />X ,- 9 � <br />�, <br />MECHANICAL <br />p�C — A/MNDLG UNITS — H P� <br />REfRIGERATION UNITS — H P. FA. <br />BOILERS — B.T.0 iN P. <br />GAS FIRED AD. UNITS — OS.U. <br />FO^.�:^ AIR 5�3TEM� <br />WALL HEATEFS — 9.TL. M <br />11NITMEATERS-8?.U. M <br />EVAPORATIVE COOLER$ <br />RANGEH000 <br />�� <br />W RTER HEATER <br />WO�OSTOVE • <br />�� <br />METAL fIf7EPLACE 6 <br />FIREPLACE INSEfiT <br />HEpT PUMP —' <br />�� <br />GAS PIPING <br />E%MAJSTFAN <br />ree <br />SUBTOTAL <br />= T <br />� � — _ ' <br />f � qECEIPTNO <br />-� PLAN CNECN NUMBE� "I FEE " I <br />V�C�NT SITE <br />pYES CNO <br />NO Oi DWEI <br />BU�LDING S <br />v�uMew� <br />MECHANICAL <br />OTNER <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCMFRGE <br />PU6LIC WORKS <br />�� <br />iTOTAL <br />PRp� p�qry pWNEqS AF7E RESPONSIBIE FOR DETERMINING ALL <br />PROPER7Y U;JE LOCATIONS AN� AELA7ED EASEMENTS. <br />