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,. ( <br /> �:��PLICATION f01:�� <br /> p E°�""" CONSTRUCTION "e ; <br /> everett PERMIT � <br /> BUILDING DEPARTMENT • <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN , <br /> HER M�ILADONESS CIfV bP PNONE � <br /> � �JYI I�-1�25 Carrl�wt, Ave� �'� �'1820( 2 2-'Sc�51 <br /> • IIkCTONDE510N fl MeILA00HE5 Clrv 21P PNONC ' <br /> � <br /> GENEMLCONTP�GTOR Mell���NESS Gn' i1P v��pNE 4CENSE• <br /> ECM�NIC�L CONT GT q M�IL�DOHE55 Cltt IIP PIIONE LICENSE• <br /> Cu.IP.�.t �'�C�.S I 1323 l-4-i4hur�Lr�9 CY�'�i# 4��- �55=T130 d�u.ENb I c.� � <br /> PLUMliNG tR�CTOR M�IL�DDRESS V (J GitY 2iP Pi�ONF LI ENSE• <br /> CL�SSOf WORN � <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIfi ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ 9111LDING RELOCATION � <br /> V�WIITION OF WONK�COST OL MATEHi�LS PLUS UBORI <br /> i <br /> DElCRIBE WONN <br /> ✓,� � <br /> use euao�He I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• � <br /> PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br /> LEG�LOESCNIPiIONOFPROPERTY�SHOWNBELOWORRII�GIIFOUPCOPiE51 pqpVIS10NSOFLAWSANDORDINANCESGOVERNINGTHISTVPE • <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> ior_e�oc�—ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLqTE OR CANCEL THE PROVISIONS OF <br /> ANVOTHERSTATEORLOCAILAWREGULATINGCONSTRUCTION • <br /> OR THE PERFORMANCE OF CONSTRUCTION. . ' <br /> SIGN�iUREOFCONiR�CTORORAUTNORIZEDAGENT D�TE <br /> - � ' � <br /> PlqlEGT�DONE53 �PPLIC i5L1tYBUSINESSLiClNSENO � <br /> �'�2.�J r A�12� . <br /> �LUMSING MECMANICAL <br /> NQ TYVE OF FIXTUNE OR ITEM ;EE NO. TYPE OF EOUIPMENT FEE <br /> WATfR GLOSET ITOILET� A/C—IVHNOLG UNITS—M.P. • <br /> BATHTUB REFFIGERATION UNITS—HP.Fi�. . <br /> UVATORY�WASlI B�SIN� BOILERS—B.T.U.MP. <br /> $lIOMIER GI1S fIRED AC.UNITS—B.T.U. �j <br /> KITCHEN$INK�OISP. FORCED AIR SVSTEMS—B.T.U.7 M FA , <br /> d3HWA5NER WALLHEATERS—B.T.U. M � <br /> UUNORVTRIIY UNITMEATERS—B.T.U. M ; <br /> CLOTMES WASMER EVAPORATIVE COOLERS <br /> URINAL CLOTMES DRVERS . <br /> pRINK11Ma FOUNTAIN VENTIUTION FAN t <br /> FLOON ORAIN RANGE MOOD , <br /> MCKfLOW PREVENTERS � WIITEH NEATER ' <br /> ppOf ORAINS—RAINLEADERS WOOD STOVE � <br /> $INK�SERVICE—BAN.ETC.� MEfAI FIREPIACE 6 CMIMNEV <br /> FIREPUCE INSERT � <br /> HEATPUMP <br /> 6AS PIPINO <br /> E%MAUSTFAN <br /> W�T(�TAL f !U!TOTAL ' <br /> K11MIT f PERMIT <br /> TOT�Li[F f TOTALfEE <br /> �NOHT SETl�CK qE�N SET&1CR Si�E SETB/�Crt �AN I:HECK NUMBEN FEE RECEIPT NO. . <br /> USf 20NE LOf�PE� VAC�NT SITE �ES VALUATON FEE � <br /> OYES ONO <br /> BUILDING 5 <br /> M1VEOFCpN51 OCCUP�NCYGBOUP NOOFOWEILINpUNITS <br /> PLUMBING <br /> SIZE OF BlD6 NO Of STORIES MA%.p��.�pAD � <br /> MECHANICAL . <br /> OTHER <br /> �FIRE SPqINNLERS REUUIRED �YES ❑ NO � <br /> STATE BUILOING SURCHARGE <br /> STATEENERGYSURCHARGE � <br /> '�PPLICAbpN�CC BV P�6N5 CMEGRED BY APPR FOF ISSU�NCE BY � <br /> � PUBLIC WORKS <br /> � TOTAL <br /> PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMININ6 ALl <br /> PROPERtt IINE LOCATIONS AND REUTEO EASEMENTS + <br />