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APPLICATION FOR ���,�„ <br /> '".E".,°."" CONSTRUCTION � <br /> cm ov <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•B810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION 4d'COM8INATION ❑ BUILDING ❑ MECHANICAL f] PLUMBING ❑ SIGN <br /> ow n nun .nm+iss cirv nr c��or+[ �p�, <br /> �/l �A/l�iif �y�� �r�E��FrlllAl� �'✓rirrl �dA 94��/ a'� /-�/d(� <br /> •Rf, f.tOROLS F IAsil POLRESS GiY IIV` VNONL <br /> fiLN[RR CONiP4G10B hlNl �ODtiC55 CiIV lIP PRONC IiCENSE• <br /> cs'e/F• - <br /> MEd1�NiG41 LONIRe/CTOfl M1l�ll ApOR65 CIIV ZIP [`tlnNC IIC[NSE� <br /> PLUMBIN000111RAG�f�R�' 1.141 Pp0�C55 CIIV 211 {IIO E IICINSL <br /> �S'� r F <br /> Guss or wOnn ,{-�� <br /> ❑ NEW ❑ ADDITION l7 ALTERATION ❑ REPAIR ❑ DEMOI.IIIUN ❑ WOOUSTOVE/FFPL.INSERT ❑ BWLDING RELOCnTION <br /> V4 WTION OL WORN�C051 Of MAICNI�_� O � <br /> � �-' 4¢, 7lvq� %� _ <br /> , <br /> DC�S IOE WOHN ... <br /> If�rr� � s iv�c a�tr �- n� n. o , p lA 2T� <br /> �5E o�a��y�,� u (����Z� n��,J <br /> �' I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP/,1- <br /> �, /V L ' PUCATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL" <br /> i[c��nescnirn FPROP[FLYi5110WNBELOWO tu.uvouncoaies� PROVISIONSOPLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> aya��� �, � ' /.1T- OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �.oi�eioc�-9� t �~ � IN OR NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> Q GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ��Tro� � Tr�A�� • ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFOFMANCE OF CONSTRUCTION. . <br /> 514NAIUN[Ol l'.ONIH4QGHOHAU1110012[OAGLNI ❑4fE <br /> X � � - � <br /> PROJECT�ODRE55 4PPLI. ITY�I SiNL551 iClNS ` <br /> � Ui!-�T7`' <br /> PWMBING � � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> W�TER CLOSET�TOILET� i '� A/C-AiNNOLG UNITS-M P. <br /> B�THTUB -- REFRIGERATION UNITS-M P EA. <br /> LAVATOHY�WASNBASIN) - BOILEPS-BSU/HP <br /> I SMOWER ' = GASFIREDAC.UNITS-BT.U. <br /> � KITCHEN SINK 6 DISP FORCEO AIR SYSTEMS-B T.U. M EA. <br /> DISHWASMER �� '- WALLMEATERS-BSL M <br /> LAUNDRY TPAV UNIT HEATERS-P T.0 M <br /> � CLOTHES WRSHER '- EVAPORATIVE C✓OLERS <br /> URINAI CLOTHESOPYERS � � <br /> DRINKING FOUNTAIN �Z VENTV.n510N FAN <br /> FLOOHDRAIN � RANGEIIOOD <br /> OACNFLOW PREVENTERS WATER HEATER J <br /> i ROOF DRAINS-RAINLEAOERS WOOD STOVE <br /> SINK�SERVICE-BAR.ETC� IdETAL FIREPLACE 6 CHIMNEY <br /> � FIREPIACEINSERT <br /> MEATPUMP <br /> GAS PIPING <br /> E%NRUSTF4N <br /> SUBTOTAI f �j�j •- SUBTOTAL r <br /> PEPMIT f - PERMIT <br /> �^._ .-_ TOT�LFEE �� � . <br /> TOTAL FEE f l� <br /> ���urnsuonr.n �- n[.nsetu.tn sroesnoncn <br /> PI.An C��ECN NlJMOER FEE RECEIPT NO. <br /> z�, � -. ' �; ' ��s � c� l� l �-- �>53 �!'� <br /> use tu��e i.otence ����rn sn� FEES VALUATION FEE <br /> � , � <br /> > urts r�o • � I <br /> "` I3UILOINC S 1�f . <br /> IVPLOf ST OCCIIPANCVGROUP NOOFDWFI.LIkG11111I5 <br /> ��- � R-3 I PLUMBING �1 ,../ <br /> tii1[Or Bi DG NO Of S10nIG5 �'�'M n�� ��'� MECMANICAL Cl� I <br /> �S3 s,F /% ^�� - � <br /> OTHER <br /> FIRE SPRINKlERS REOUIRED ❑VES NO STAiE BUILDING SURCHARGE '1 � <br /> STATE ENEHGY$URCHAfiGE <br /> FVCIlLF110NACC �� PlANSLN[CNCDBY APPP 1'OPISSl1�NCE0v �UBUGWORKS <br /> �r�•I�N� � � /.1.Q. TOTAL ' ,•� i � <br /> � <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCAilONS AND RELATED EASEMENTS. <br />