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Y� 1 � �r <br /> � : <br /> ��PLICATION FO� <br /> '� ""E"'°"'" CONSTRUCTION °��"" <br /> ' ' cm or <br /> ' everett PERMIT e <br /> BUILDING DEPARTMENT <br /> '; � 259-8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING '�,MECHANICAL �PLUMBING ❑SIGN <br /> o��CR� f/ K�SQlV Mu���s TG�S J�cm zia .J N��e�09� , <br /> •RCHITECTON FSinNEP MML�ODPE55 � fV ZIP PHONE <br /> GENEPAI GONLR�GTOR MUL AOORE55 C��' 21P nHONE uCENSE� <br /> iiMECNI�NiC•ICOI//�OA /V ��`^D/E�51�/ • / V '`�V C/ I�L-/�/�//v l N ' //Jr LI�E• � <br /> [s�'Ly ��S - S <br /> PIUMBI GCONTR�GIOv M�IL�OONE55 CITY � ZI��� PNpN���� �ICENSE• <br /> ' %\ <br /> C1�550f WORR <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOO�STOVEIFFPL.INSERT ❑ BUILD�NG RELOCATION <br /> V�LJJ��N OF WOAN ICOSi OF M�IERI�LS PLUS L�BORI <br /> a /)A1I1 <br /> �N I�W i <br /> �5C�7"�LL �U�I�IG£ tf-- W'�-�.� ��}T�.�Z <br /> usgor�oiH I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS AP• <br /> % ' <br /> PLICATIONAND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> lEO�IOFSGRiPTIONO�PNOPENiY1SNOWHBEIOWOR�TT�CHfOURCOPiE51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or_eioc�_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE �'ROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATINQ CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIONATUREOFCON7R4CiORORAUTNOR12E0ACENT OATE <br /> � X U/Iil� �— l/—�s 8' <br /> '� VRO��Dp 8 �EG�S ��lV� APpLIG�NiStDIIV�51NE551i�5EN0 <br /> ES <br /> ' vti 69 <br /> PLUMlIN6 MECHANICAL <br /> NO. TYPE OF flXTUqE OR ITEM FEE NO. TYVE OF EOUIPMENT FEE <br /> I WIITERCLOSET�TOILET) AiC—MMNOLGUNITS—H.P. <br /> �;� BATNNB REFRIGERRiIONUNITS—HP.EA. <br /> ! UVATORV�WASMBASIN� BOILERS—flTL1M.P. <br /> SFIOWER O�S FIRED A.C.UNITS—B.T.U. <br /> IfITCMEN$INK e OISP. FOHCED AIR SYSTEMS—B.T.V. M EA. <br /> 019MWASMER WA��HEATERS—B.T.U. M <br /> UUNDRV TRAY UNIT MEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPOFATIVE COOLEPS <br /> j URINAL CLOTHESORYERS <br /> DRINKING FOUNTAIN VENTIUITION FAN <br /> PLOOR DRAIN RANGE MOOD <br /> I <br /> BACKF�OW PNEVENTERS WATER MEATER <br /> � ROOFDRtINS—RAINLEADEFS WOODSTOVE <br /> j SINK�SERVICE—BAR.ETC.� MEfAL FIREPUCE d CHIMNEV <br /> � FIREPLACEINSERT <br /> t <br /> 'S HEAT PUMP <br /> GAS PIPIN6 <br /> EXHAUSTFAN <br /> SUSTOTA� f SUSTOTAL <br /> PERMIT ! P[RMIi <br /> TOTALfEE f TOiAI�EE <br /> f PONT SEiB�LR REAR SEtBACN SmE SErB�CK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USE20NE LOTAPE� yAC�Ni51IE FEES VALUATION FEE <br /> OYES ONO <br /> BUILDING S <br /> TYPEOFCONST OCCUP�NCYGROUP NOOFDWELLINOUNITS <br /> PLUMBING <br /> SREOFBl�O NOOFSiORIE3 Me%OCCLOAD ��� <br /> MECHANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑VES O NO STATE BUILDING SURCHARGE <br /> i <br /> STATEENERGVSURCHARGE <br /> I �MpLiGF110N�CC 0� PUNSCMECKEUBY �PPp FORISSUANGEBY <br /> PUBLIC WORKS <br /> TOTAI <br /> � PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMININO ALL <br /> PROPERN L�NE LOCATIONS AND RELATED EASEMENT�. <br /> ..r-...-.�.. .,.,-.,- .. �. ...�.r.... . ... .... .. . ... . .. . ��. . . ,.....-. .r . .. ... . <br />