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. �PPLiCATION FO►. ���,�„ <br /> fME�+ryM� CONSTRUCTION <br /> ur os � <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL �LPLUMBING ❑SI(iN <br /> QWN q M�II.AOONE55 CIIY ZII' PMONE <br /> �-�}r►ri � cl�Si �� `'� �S �AIF�F�I- �R�f -�S�-C1Iq � <br /> •RCMITECTORDESIGNEq M�IlAODN[SS Lltt 21P i101�1L <br /> GERENALCONTR�GiOR M�LL a00pE55 GfY ZIP PIION[ UGENSE• <br /> �F`�� <br /> MECN�NIG�L LONTMCTOfl AUIL�OOfiE55 CIfY 21P PIIONE IICENSE� <br /> PLUMBIN4 CONTRALTOR MML�DOf1E55 CiTY 21P PIIONE LICENSE• <br /> GL�SS OF WORN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING NELf1CAT10N <br /> V�W�TION OF WORN�COST OF M4iERIALS PLUS UBOflI -- <br /> �fSCRIBE WOPN <br /> USEOFBUILOINO I HEREBY CERTIFY Tf1AT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BETRUE ANDCORRECT.ALL <br /> LE6�LUESC9IPTIONOFPROPEHTV�SMOWNO[LOWOR�iTAC11FOlINCOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> IOT�BlOL1L_OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANYOTHER STATE OR�OCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATl1RE OF CONIHRGTOR OR AUTMORIZED AGENT DATE <br /> X <br /> PROJECT�DORE55 �PPIIL�NTS CIIY OUSiNE55 LiCENSE NO <br /> PLUMSINO MECHANICAL <br /> Np, TYPE OF FI%TUNE _ FEE NO. TVPE OF EOUIPMENT FEE <br /> W�TER CLOSET�TOILEn AIR COND. UNITS-H.P.EA <br /> BATM�UB _ REFqIGERATION UNITS-H P. EA. <br /> LAVATORY�WASH BASIN� 9011ER5-H.P. EA. <br /> SHOWER GAS FIRED A C. UNITS-TONNAGE EA. _ <br /> KITCMEN SINH 8 DISP. FOFCED AIR SYSTEMS-B T.U. M EA. <br /> DISHWASIIER WALL MEATERS-B.T.U. M <br /> LAUNDRVTRAV UNITHEATEFS-BT.U. M <br /> CLOTHES WASHER - EVAPOR�TIVE COOLEHS <br /> WATER MEATER CLOTHES DRVERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HO00 <br /> FLOOR DRAIN A�R HANOLING UNIT- QF.M. _ <br /> VACUUM BREAKERS STOVE <br /> NOOF DRAINS-RAINIEA�ERS METAL FIREPLACE 8 CHIMNEY <br /> SINK SERVICE-BAR.ETC. WOOOSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUBTOTAL i <br /> PEPMIT S PERMIT t <br /> _ TOTAL FEE i y�� _ _ _ TOTAL FEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONTSETB�CK pE�RSEIBAGR SIOES[tOACK PlRNp1ECNNUMBER PL�NGIIECMiEE <br /> fEE AECEIPi NO <br /> USE20NE LOTAPE� VAC�Ni511E V�LU�TION FEE <br /> OYES ONO FEES <br /> TYPEOFCONST. OCCUPPNCYGPOOP NOOFOWEllINOUNITS <br /> BWLOING f <br /> 512E OF BI�G NO OF STORIES M�%OCC LO�D <br /> PWMBING <br /> MECHANICAL � <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO � <br /> OTHER <br /> PENALTY <br /> RPPLICATION�CG.BY PLANSCMECKEOBY �PPNFORISSU�NCEDY <br /> � TOTAL <br /> ( <br />