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(;-.PPLICATfO�N FO`� <br />'".E".`°'"" COR�STRUG�ION <br />CIiY OF <br />everett PE RM il" <br />BUIIDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />�DEMOLITION ❑ COtA01NAT10N ❑ 9UILDING 7 MECHANICAL <br />)��WNER / MA�I�DORE55 / CItY GZI[G' <br />� !1 � /l �i wm or C i �(� � ��-,-.% �'7'C� /},lP � �vL' YG//� / 6 0!1 <br />O PLUMBING <br />3- <br />�verett <br />� <br />❑ SIGN <br />•RCNIL Gi OP 0lSiGNEA MUL AODPE55 CrtV ZIP PnONE � <br />GENEP�L GONi�R�AG�1/0fB MUL PDORESS G�1'� ZiP �HONE 4CENSE • <br />MEf.H/�NIC.LCOMTFPLTOq �IA�Lr���RE55 CIIV ZiP P69NE LILENSE• <br />� PLUMBING <br />NAI� ADOFE55 <br />ZIP Pr10NE LICENSE • <br />0"NEWV ^� ADDITION ❑ ALTERA�ION ❑ REPAIR �( OEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ 3UILDING RELOCNTION <br />MIUAiION Of WORK ICO51 01 MAtERIAL51`LUS U9JR1 <br />P�ROJE/LT�ODRtSS <br />.c3[� �� _' <br />. PLU�—..�— <br />� <br />n <br />0 <br />I HERI=BY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />� / C�r pUCATICNANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />iAGMFOURCOP�ES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />�/ OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />� 1 IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />� 3 ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR T'riE PEFFORMANCE OF CONSTRUCTION. <br />/"QV SIGN>I O�nCTORO�/� AGENT DATE�/�/('�r� <br />lJ �/ (j � <br />X � <br />� �" UG', �� 7��/4�, r1�-?o/ — <br />i Np, TYPE OF FIXTURE <br />� �WATER CLOSET �TOILET� <br />I <br />iWASH BASIN� <br />K17CHEN SINN 8 DISP <br />DISHWASHER <br />LAUNORY TiIAV <br />CLOTHES WFSNER <br />UFINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAiN <br />BACKFLOW PREVENTERS <br />ROOf DRAINS — PAINLEAUEHS <br />SINN �SERVICE —BAR. ETC � <br />f PONT SE1B4L8 <br />USE 20NE <br />' ttFEOFCONST <br />�. Si2E O� BlD6 <br />FIRE SPRINKLER <br />nvrucxuon acc e. <br />SUBTOTAL <br />PERMIT <br />TOTAI FEE <br />RE�R SEIBaGH <br />LOi aRE/. <br />OCCUP�NGYGROUP <br />� <br />f <br />S <br />SiOE SELB�CN <br />Vp:�Ni SrtE <br />C"ES ONO <br />NO OF OWELJNG UNI1S <br />MAN OCL LOAD <br />APPq (ORISSU�NCE B� <br />� �� � <br />MECMANICAL <br />NO, TYPE OF EOUIPMENT <br />qiC — A/HNOLG UNITS — MP. <br />REFRIGERATION UNITS — H P. EA. <br />B41LEF5 — B 7' U/H P. <br />GAS FIREO A.G UNITS — B.T U. <br />FOQCED AIR SYSTEMS — B T.U. M EA. <br />WALl4EATERS—B.T.U. M <br />UNiTMEATERS—�.T.U. M <br />EVAPDRATIVECOOLERS <br />CLOTNESORVERS <br />VENTILATION FAN <br />RANGEHOOU <br />WnTERHEATER _ <br />WOODSTOVE <br />METAL fIREPLACE 8 CHIMNEV <br />FIREPLACEINSEPT <br />HEATPUMP <br />GA$ PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOT�LFEE <br />PLnN CMECNNUMBER IFEE <br />BUILOING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SU�CHAFGE <br />STATEENERGYSUFCHARGE <br />PUBLIC WORKS <br />TOTAL <br />RECEI�T NO. <br />FEE <br />PROPERTY OWNERS ARE RESPONSIBLE FOFi DETERMINiNG ALL <br />PROPERN LINE LOCA'IONS AND RELATED EASEMENTS. <br />. __ _ ._.......—.,__._ � - ..� <br />