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.-. . . <br /> HPPLICATION FO�. ���.�n <br /> '"'E"'°'"" CONSTRUCTION e <br /> CITY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8870 TO BE COMPLETED IN INK• PLEASE PRINT <br /> 0 DEMOLITION � COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> QWH�q M�ILAD�AE'i5 CIiY 21P PNONE <br /> � � % � �. , Ck,f�., R �,�,,. � P�� �11 �, ; Pd �� �s� �.,s. y8oz� ��y_ 2�i z <br /> ♦qCNITECT OH OESiGNER MAiL A��NES C tt Z P ONE <br /> GFN[flALCONTRnCTOR MSIL��0AE55 C�n' LIP PHONE LICENSE• <br /> MELNANIGLCONTR�CTOR MML�DDRE55 dTV EIP P��ONE IiCENSC• � <br /> PWMB�NGCONTR4CiOR MAiLP0�AE5S CiTV IiP Pi�ONE L�CENSE• <br /> _j�/�.!�,, �� D� � /o� �4-v c � .Sn��; Y4� SO �GK-u�=3 � .q�730�/�/�' N <br /> G1�550f WOA" � <br /> �NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V4L WT�ON 0�K'OFN ICOST OF MAtERi�IS�5 LFBONi <br /> � <br /> UESCRIBE WORN <br /> l� <br /> usE ov eu��o� c _ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> e <br /> �2 (fC /�Gh. C c PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEWL�ESLRIP110NO�PpOPEPTl15MOWNBELOWOFRiTALNFO A�OPIESI pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> io�—e�or.K—oF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHCRITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNATURE OF CONTRACTOR OR AUiHORIZED AGENT 04TE <br /> ♦ . � �� .�- <br /> X a y 2� ' a`— <br /> APPLIC�N SCITYBUSINESSIiCEN5EN0 <br /> Pp0!EGT�DOPESS <br /> /� <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF rOU1PMENT FEE <br /> WATER CLOSET�TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATNTUB �EFNIGERATION UNITS—H.P.EA. <br /> U�ATON�IWASH BAS�NI BOILERS—B.T.U./H P. <br /> SNOWER GAS FIREO AD.UNITS—B.T.U. <br /> KITCHEN SINK 8 DISP. PORCED AIR SVSTEMS—B.T.U. M EA. <br /> DISMWASHER <br /> WA�I,HEATERS—B.T.U. M <br /> LAUNDRVTRAV <br /> UNIT MEA7ERS—B.T.U. M <br /> CLOTMES WASHER EVAPOMTIVE COOLERS <br /> CLOTMESDRYERS <br /> URINAL <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR�RI11N RANGE HODD <br /> BACKFLOW PFEVENTERS WATER HEATER <br /> ROOF�RFINS—RAINLEADERS WOOD STOVE <br /> SINK ISERVICE—BAR.EfCJ � METAL PIREPLACE d CHIMNEV <br /> FIREPUICE INSERT <br /> HEATPUMP <br /> GAS PtPING <br /> E%HPUSTFAN <br /> � SUSTOT�I f � SUBTOTAL _ <br /> VERMIT f V[flMIT J <br /> TOTALFEE f � MTALFEE <br /> �aOM SEiBACn RE�H SETBACN Si�E SETB>CN <br /> PI.AN CMECK NUMBER FEE RECEIPT NO. <br /> usemec ior�ae� y�LANT5ITE FEES VAWATION �E <br /> ❑rEs ONo S <br /> BUILDING <br /> rVPE0FC0Y51 OCCUP�NGYGRUl1P NOOFDWELLINGUNITS ` . \ <br /> PLUM9ING � �.J <br /> . SiZE OF B�Dc NO O�STOPI[5 M�x OCG �OAU MECHANICAL � � <br /> — OTHER / <br /> FIRE SPRINKLERS REOUIRED ❑ VES ❑ NO STATE BUILDING SUPCHAfiGE <br /> $TATEENERGYSURCMARGE <br /> aVFI i�<I10Y<CC B� PLANSCNECKE�BV PFPR FOR ISSUANLE BV PUBLIC WORKS <br /> � � � <br /> TOTAL <br /> PROPERTY LOINE LOCATONS AND REBATED E SEMENTISING ALL <br />