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�. .�� <br /> HPPLICATION Fv� ���,�„ <br /> `"'E"'°"'" CONSTRUCTION e <br /> LITY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PPINT <br /> ❑ DEMOLITION ❑ COMBINATION �1 BUILDING ❑ MECHANiCAL O PLUMBING ❑ SIGN <br /> CWHEA M�IL�ODRE55 CITY ZIP PHONE <br /> �v�r�D F/fc s�,11,�— ,�ZLVA�rF� E✓�i fT /r'd x3 ��-��6� <br /> ,��-Tr� MaIL AODPESS CiT' P P ONC <br /> 5��; rr`= An-���t/RkL /kirs� .lfr.� �� ����.�.,�.1 �Poqc 7�J'- 7��4- <br /> GCNGR�L CONTRACIOR M I+DORESS itt IiP oHONE LICENSE• <br /> �• <br /> '/ECr'nHif,�LGONTR�COqr C������ __y� �� �^���_)� , ^^/�^O P��ONE � LiCENSE• <br /> >Y`".'� �y � =i��i`j S�C�'� ISBD� <br /> PLUMBiNGCONTR�LTCR MAR�O�AE55 CITY 21P���` P���I LiCENSE • <br /> CL�55OF WORN <br /> ❑ NEW SH ADDITION ❑ ALTEfiATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPl.INSERT ❑ BUILDING FELOCATION <br /> VALW �ONO(WOFnIWSTOFMAfERiqL5PLU5LABORI <br /> 8� d o "Q <br /> DE CRIBE\1'JAN <br /> Nc '�� - � !.� CLJ � -Tr ,�� - ,�� ���. <br /> U5E OF BUi�DirvG t HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> c ✓ I/f PLICATIONANDKNOWTHESAMETOBETRUEANOCORRECT.ALL <br /> �c NLOESCRIPT1�IO�ORDPERiYSHOWNBElOWO ATACNFOURCOP�E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br /> LO�-BLO�rc_OF IN OR NOT.THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO <br /> � GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVIS�ONS OF <br /> — .�p o — /.p— ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE 0 QN ?RUCTION. <br /> 6 ^ �)E $IGNnTUREO�CONiP4C UTHORiZEDAGENT 04TE y/��` <br /> Y Ra�/✓F��� / 0 <br /> �r � <br /> PPOiE.:T�ODFE55 AP if. SGIiVOU �NESSL�GEHSE�� <br /> ��o /�/�✓E / (.�'il�?1 �IfC. /✓ L ,j�✓G . <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIRTURE OH ITEM FEE NO. TY7E OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� A/C—A/HNDLG UNITS—NP. <br /> BATMTUB REFRIGERATION UNITS—M P.EA. <br /> LAVATORV 1 WASM B�SIN� BOIlERS—B.T.0 IH P. <br /> SMOWER GAS FIRED A C.UNITS—B.T.U. <br /> KITCMEN SINK d DISP. FORCED A�A SYSTEMS—B.T.U. M EA. <br /> ��SHWASMER WALLMEATERS—B.T.U. M <br /> WUNORVTRAV UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAI CIOTHESORYERS <br /> ORINKING FOUNTAIN �ENTIUITION F.1N <br /> FLOOR DRRIN RANGE HOOD <br /> BACKFLOW PREVENTERS WATEF MEATER <br /> / ROOFDPAIN$—F4INlEADERS WOODSTOVE <br /> SINK�SERVICE—BAR.ETC) METAI P�NEPLACE 8 C111MNEY <br /> FIREPLACEINSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> E%MAUSTFAN <br /> fUOTOT�I f SUSTOTAL <br /> PERMR f P[RMIT <br /> TOTAL FEE ! T0T11L FEE <br /> i aoNT SETO4Cn RE�R SETBACK SiDE SEIB�CK 7lAN I;HECN NUMBER FEE � AECEIFT NG. <br /> _ , g � /za�a ��Id 13Z4 <br /> usezuvc ior�ae� VALUATION FEE <br /> VRCANT SITE FEES — <br /> I �j <br /> 2 ❑rE5�+0 BU�LDING 5 �� � CJ 1� C�j <br /> rvV[OfCONSi OCCUPANCYGROUP NO.OFDWELLINGUNRS <br /> �� /v � - Z '!}• PLUMBING <br /> 59F.Ofi:P!f�,I���n NO OF STORi[5 NA% OCC LOAD <br /> MECNANICAL <br /> 3 (00 Sf � � � <br /> OTHER <br /> FIRC SPRINKLERS REOUIREO ❑ VES NO � ' <br /> STA7E BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> aCV1�CAliO4nCC Bv PL�NSGNEC1tE0BY APF0.fOR155U�NCEBY PUBUCWORKS <br /> ;bl ��'1 /yG- /,�c.- TOTAL r <br /> PROPERN OWNERS ARE RESPONSI'7LE FOF�ETERMINING ALL <br /> PROPEFTY LINE LOCATIONS AND RELATLD EASEMENTS. <br />