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�:��PLICATION FOR ��� � <br /> fMEwrpn�n CONSTRUCTION � �`e <br /> GTY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION 9'COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> OWN�O�H /�. CQ/ YI M�ILZ�IO l E��/-� SG� C(; !� Zl4Ld8 PHON���-�J 7I <br /> LTvf <br /> •NCIIttECiORDFS�GNEN MML�OORE55 CILY 2iP PNONE <br /> GENERAICONIReG10R MMLnDpR[SS Ci1Y t�P PPONE UCENSE• <br /> 04.N�r' <br /> MEf.11�NIf.�LGONTRACTOq MeILA0DRk55 CIIY ZIP PIIONE UGENSE• <br /> PWMBIN.CONIfl�GIOR M�ILADDPG55 , . ..CIIY IIP PIIONE IICENSF� <br /> f.L�55 Oi WURR <br /> ❑ NEW ❑ ADOITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCAT�ON <br /> V�WAiION OF WORN�LOST Of MAICRUlS PWS LA�ORI <br /> l�Odd <br /> OESCHiHE WORN L nO �/� CJ�I. \ IL <br /> ���dC �Q O,V/� lrY� �a 2 S�v.� Gwi�l � � ' r� l� J� � t�Y_ ..� <br /> USE OL BUIlOING <br /> I HER[BY CERTIFY THAT I HAVE READ AND EJfAA11NED THIS AP• <br /> Yye�✓....�+ � PLICATION AND KNOW THE SAMETO BE TRUE ANDCORRECT.ALL <br /> LEG�LDESCRIPTIONOFPqOPERTY�S110WN8ElOWOR�1TAGnfOUNGOP1E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � �P�Q OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDNEAE- <br /> �oi�eioc��or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PAESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> 'j D'00 - ef3 7 ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORA9ANCE JF CONSTRUCTION. . <br /> SIGNATURE Of CONTRACTOR OR AUTMORIZEO FGENT DATE <br /> � /l�i..,� iQ_ ��.... /l�v�. 1Y, !�� 7 <br /> PNOIELT�ODHESS ��'PLiC TSCIIYOUSINESSLICENSENO <br /> 2�//Z �/�i GCi.��rd /1�.t^. ��r,tb� !li.s 9li2al <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FcE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AiC-RiHN�LG UNITS-H.P. <br /> BATl1TUB REFRIGERATION UNITS-M.P.EA. <br /> V.`lATORY IWASM BASIN� �j � U BOIlERS-BJ.LL/M P. <br /> SMOWER GAS FIRED AC.UNITS-B.T.U. <br /> KITCHEN SINK 6 DISP. FORCEO AtR SVSTEMS-8 T.U. M EA. <br /> OISHWASHER WALLHEATEFS-B.T.U. M <br /> UUNDRY TRAV UNIT HEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHE50RYER5 <br /> DRINNING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN RANGE HOOD <br /> BACKFLOW PNEVENTERS WATER HEATER <br /> ROOF DNAINS-RAINLEADERS WOOD STOVE <br /> SINK�SERVICE-BAR.EiC� METAL FIFEPLACE d CMIMNEV <br /> FIREPLACEINSERT <br /> NEATPUMP <br /> GAS PIPING <br /> EXIIAUST FAN <br /> SUBTOTAL f SUBTOTAL <br /> PERMIT f - P[RMIT <br /> TOTAI FEE f ( TOTAL FEE C� <br /> ruoHi5E1B�Cn REeRSEtBACK 9DESEiB�CR �ANCMECNNUMBER FEE pG PECEIPTNO. <br /> /� � 2n � 5 � Sl I `��0�� � 37Q�1 <br /> usemee {� LOT�/PE♦ V�GANTSITE FEES VALUATION FEE <br /> R- / (�z S D ❑YES ONO - � <br /> BUILDING S <br /> 1YY[OiCONSf OCCUPANGYGflOUP NOOFOWELLINdUNITS <br /> 'r t �i�N �- '� / PLUMBING Lj (`j <br /> SiZE Of BI DG NO OF SiORIES MA% ppC LO�D <br /> �`Q � / N� MECHANICAL G G <br /> OTHER <br /> FIRE SPRINHLERS REOUIRED ❑YES �NO STqTE OUILOING SURCMARGE � ,5� <br /> � <br /> STATE ENEFIGY SURCIIARGE <br /> cl'PLif.ailONACf, pv P�ANSCNEGNEDBY �PPRF0815SU�NLEBY <br /> PUBLIC\YORKS / �/ <br /> � �i` � TOTAL OU <br /> PROPERN OWNERS ARE RESPONSIBLE FOR DETERMINING ALL • <br /> PROPERTY LINE LOCATIONSAND RELATED EASEMENTS. <br />