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S�.�PPLICATION FOI.� <br />M•Ewryrwn CONSTRUCTION � �v��en <br />cm oF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION QiBUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER ����L��ORESS CITV 21P PNONE <br />� ... . .i.. . �-- ..... ... .... � � isL i.... �� '7i �in Jli/rnr_y1 2CS =.S%i/ <br />SS �?o. 3ux e 3��2- `". '. <br />s ,EOoro.vAs 9�-u <br />OENEN�I CONLR�CIOR MML �ODRE55 C�tV !iP PI�ONE UGENSE • <br />7�� �o,..e�T Sf'.2✓:ars S�n.�' 9s /dz3uvL i�c�sf99�3 <br />MECHANiGLCON1NeCiOq M�IL�O�RE55 CtIY 21P PHONE ULENSE� <br />PWMBiNdCDNiR�GTOR M�II.�ODRE55 CitY tIP Pi�ONE LICENSE� <br />❑"NEWV^^'�' A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCFTION <br />� . e <br />�o��_ewc�� <br />PLUMSING <br />r� <br />SINK A DISP. <br />DRINNINO FOUNTAIN <br />FLOOR DNAIN <br />B�CKFLOW PREVENT <br />ROOF DRAINS — RI1R <br />SINK ISERVICE — BAi <br />L <br />�iuc�� <br />ITEM <br />Lt%.6L <br />8US �OTAL f <br />PEpM17 f <br />TOTALFEE s <br />acctn¢K SIpE <br />lISEZONE �LOi�RE� <br />OCGUPANGYGROUP <br />.q110N RCC BV <br />M,6v� <br />FEE <br />V�C�NT SIiE <br />❑YES ONO <br />NO Oi OWELLINO UNIfS <br />erru vonissu�Nce <br />�; <br />IE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BETFUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SI�NATURE Of CONiRRCTOR OR AUTMOFIIEO AGENT ��TE <br />� e�r'iv� �U -/ S - 8 % <br />�VPLIC�Ni5C�1VBU51NE55UCE NO <br />MECHANICAL <br />TYPE <br />— A/HNDLG UN <br />BOILEPS — B.T.UiH.P. <br />GAS FIREO A.C. UNI75 — B.T.U. <br />FOPCED AIR SVSTEMS — B.T.U. <br />WALL NEATERS — B T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WIITER MEATER <br />WOOD STOVE <br />METAL FIREPLACE d CHIMNEY <br />FIREPUCE INSERT <br />OAS <br />VLAN CMECN NUMBER <br />BU�LDING <br />PLUMBING <br />MECHANICAL <br />SUBTO <br />fKRMIT <br />TOTALI <br />I FEE <br />STATE BUILDING SURCHAFG'� <br />STATEENERGYSURCMARGE <br />PUBLIC WORKS <br />TOTAL <br />$ <br />M <br />M <br />RECEIPT NO. <br />PFiOPERN OWIJERS ARE RESPONSIBLE FOR OETERMININO ALl <br />PROPERTVLINE LOCATIONSAND RELATED EASEMENTS. <br />_ ;y,_ , ;i. .r.� '�: :.�_; <br />