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IM EwrprMn <br />GITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />A�PLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ]i COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MMl �D�RE55 CItY 2iV PNONE —_—" �K3y'l• Y�'� _ <br />CI1V <br />AnniiF' - <br />fiENENet GONTPALIOR M�11 �fIDAC55 G 1Y !IP �'I�ONE IICENSE • <br />MEGH�NILoI CONTH�f.TOq ra��i �nnness CITY 21P PMONE LICENSE • <br />PLUMtliN CONTN�CfOR MAl14DOAE55 Ci1V li� PUDNE IiLENSE• <br />GeL��SS OF WORN <br />yp� NEW ❑ AUDIiION ❑ ALTERATION ❑ REPAIR � DEMOI.ITION ❑ WOODSTOVE/fRPL.INSERT ❑ BUILDING flELOCATION � <br />V� W �1�ON Oi WOAK ICOST Of MaiCRULS Pl U51.�BOAI <br />.. . . . ._ ._ .. ,. _. _ _ �J' c- n.,n <br />WONN <br />x�5riti16 4 <br />L <br />cvr-R� r r ,,�a <br />ABo ✓ � <br />PLUM8ING � ' <br />NO. TYPE OF fl%TURE OR 1' <br />W�TER CLOSET �TOILET� <br />BATHTUB <br />LAVATORY �WASM BASIN� <br />SNOWER <br />KITCHEN SINN S �ISP <br />DISNwASNER <br />UUNDRV TRAY <br />CLOTNES W�SHER <br />URINAL <br />DPINKING FOUNTAIN <br />FLOOR DRAIN <br />811CKFLOW PREVENTERS <br />ROOF DR�INS — R�INLEAOEFS <br />SINK �SERVICE —BAR. ETC � <br />SUlTOTAL <br />PERMIT <br />TOTAL FEE <br />�RONiSEtBACK RE�RSETB�CK <br />�, <br />{� - Z <br />VPC Of CONST <br />��� <br />',i�F pi !1G <br />�� <br />wo ; c. <br />°IRE SPRINKLERS RE <br />U'PIIG4f10N�CG OY <br />;� � V <br />S <br />� � <br />� l'I�EGMED OY <br />ib� <br />�-, <br />C�] <br />�, <br />VeC�tt� $��E <br />❑YF�NO <br />NO 0� DWFLIING UNITS <br />� <br />Mez occ ioeo <br />N.4 <br />ronissu• <br />r� <br />� Rl�l3ul�D NEW CA�AC,E <br />I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF GONTRACTOR OR Al1iHORIZEO AGENT OATE <br />X %%Ci,�- � /'.c:e:�-�" %�/�ZB�87 <br />•PVLIL�NTti CITY BlI51NE55 UCE N9E NO <br />MECHANICAL <br />A/C — A/MNOIG UNITS — HP. <br />REFRIGER�TION UNITS — M P. EA. <br />BOILERS — B.T.0 /H P <br />GAS FIREO AA. UNITS — B.T U. <br />PORCED AIP SYSTEMS — B T.U. <br />WALL MEATERS — B T U. <br />UNIT MEATEHS — B.T.U. <br />VENTILATION FAN <br />RIINGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 6 CMIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />CAS PIPIN6 <br />ExM�uSTFAN <br />SUSTOTAL <br />PLAN CMECK NUMBER <br />�� / 193s <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BUIl01NG SURCHARG <br />STATEENERGVSURCMAAGE <br />PUBLIC WORKS <br />TOTAL <br />rse <br />M <br />M <br />M <br />FEE PECEIPT NO. <br />`tG �= 9 <br />v��uanoN � <br />5 �' /lr�,r � <br />PROPERTY L�INE L CATIONS AND RELATED E SEMENTISIN� ALL <br />