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A PLICATION FOR � ���,�„ <br /> �^.E�.°'�° CONSTRUCTION e <br /> cin oF <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL C PLUMBING ❑ SIGN <br /> .c J�'P� o" s� cm zic aHor�E <br /> °Vk�9`�.fl. /�. �� �� - FUil7cr105 Glbn Zo -77q-Z7l Z <br /> /' �z�z�>,��� - ai«Fin��r- �-N� ac ��TM Z�� PNONL <br /> hRCNITICi OR Jf$IGNER MNIL AOOPE55 <br /> F'i/iKGy�R^���-i�c75 N�� /�G/Z N�w�>t/�a, `L��/'.��77 __ ,")BI,��c� �'S8 �� 7/ <br /> MaIL aDOAE55 C*�' LIP �uON[ uCENSE• <br /> GFN[NAl CONiFFCTOR PU�RTWY <br /> FL�Gr✓r" ur�5� Cv1'V /5�« Oii;-Ia�U i=r���oN�JS `igv2o -�-z�-z�iz �s� ��4- <br /> / �7�2v�55 �� `iv zir r��or�E ji3H�F F�A • <br /> e�LC��nr�ical CONTanGiOR c, U1) � {O} Z ��l /_ 7JzU <br /> /1j¢h' Ll"`/1Tl`�� .�G Jh� �-'Li7�s�J,vD cur�_ o C.�>45e-V <br /> PWMBIN aCONiP4C�OF <br /> M1IRII.ADDRE55 CiiY 2iV Pi�ONE uCLNSE • <br /> CI�550�WOA�'. <br /> [Y NEW ❑ ADDITION I�. ALTERATION ❑ AEPAIR � DEMOLITION ❑ WOODSTOVE/FRPL.INSERT BUILOING RELOCATION_ <br /> VALUPiiONMWO��ICOSiOGMA1ERIPL5�LU5LPBORi �o�TN ! ✓L✓�� � <br /> l�Z �s�icu�n> N `c•l w�I-^� <br /> OFSCRiBE WORK <br /> 3 �� `Lb�•i,�L. 1�/.%t?1�i z ��1fi,S <br /> USE Oi BU�IDiNG I HER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �5.���j�qr��' ° j PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEG4LDESCRIPilONO��'AOPERfY15MON'NBEIOWOAA1tACHFOURLOP�E$I PROVISIONSOFLAWSANDORDINANCESGOVFRNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED MERE- <br /> i�i_e�oc�—aF IN OR NOT.THE G'7ANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> 5/ � � ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR TH PERFORMANCE OF CONSTRUCTION. <br /> SIGNPT'�. F GONTPACTO AUT OR�ZEO AGENT OATE <br /> Sou i„ .yG X� �__��v"�1___ I2 Z �� <br /> PPPLIfANTSCIiVBU$INFSSU LNSE � <br /> PROJECT�ODRESC ` �� /�I� �O� ^ I�� r ���✓ � <br /> v� Y_ � 1NL� nc'-f f�l c�"CS <br /> �`G (.��'�-' �r <br /> MECHANICAL <br /> PLUMBING FEE <br /> Np. T1�PE OF FIXTURE OR ITEM FEE NO. T'PE OF EOUIPMENT <br /> qiG-A/MNOLG UNITS-MP. <br /> � W�TER CLOSET�TOILET) <br /> REFRIGER�TION UNITS-MP.EA. <br /> BATMTUB <br /> BOILERS-B.T�U iM P. <br /> LAVATORY IWASM BASINI <br /> GAS FIRED A�C.UNITS-B T.U. <br /> SHOWER <br /> FOFCE�AIR SYSTEMS-B.TL. M FA. <br /> KITCHEN SINK d OISP. M <br /> WA��MEATERS-B TL. <br /> DISHWASNEF M <br /> UNIT HEATERS-B.T.U. <br /> LAUNDFVTRAV <br /> EVAPORATIVE COOlERS <br /> CLOTHES WASHER CLOTNES DFVERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN qqNGE HOIJD <br /> FLOOR ORAIN <br /> WATER HEATER — <br /> BACKFLOW PFEVENTERS WOOD STOVE <br /> HOOF DRAINS-RAINIEADERS ME7q�FIREPLACE d CMIMNEY <br /> SINK ISERVICE-BAR.ETC I FIREPLACE INSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> 4UlTOT�L f ____.___- <br /> SUBTOTAL <br /> p[pM1T <br /> pERM�T f TOTAL FEE <br /> TOTAL FEE f <br /> � p�prv i.M CK NUMBER FEE PECEIPT NO. <br /> �NpNi5E1B4C„ NEAB SEiBACN SIOE SETB�C p <br /> Zv 20 .� � /o ' 7'S1 l /��� "3 � ��Y � �l � <br /> _oraAe• FEES VALUATION FEE <br /> USE LONE � VACANi SIT[ <br /> �,� C��^� ❑rEs �NO BUILDING g - �I���GL� <br /> H' <br /> 1VCEC�GONSi OCCUPANCVGROUP NOOFOWFLLINGUNRS <br /> �.1_ � I f l� l� — I S v�uMairic <br /> 9.[OF eIDG No Of S/io�NiES MAx oCC IOAD MECMANICA� <br /> ,.. �� �� � ') , <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO STATE BUIIDING SURCHARGE �Z -� <br /> STATEENERGYSURGHARGE / <br /> nVF�.iC�i104 aCC 6� PL<NS CHECe[U BY AP�R cOq ISSUANGE BV pUBL�C WORKS �� ��I� /�I <br /> ^�J� ��� ���� TOTAL "G <br /> ��v\ <br /> PFOPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AlL <br /> PROPERTY LINE LOCATIONS AND RELAlEO EASEDAENTS. <br />