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� APPLICATION F�R ' ���,�„ <br /> '".`"'°"'" CONSTRUCTION � <br /> CITV OF <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT. <br /> 259-8745 ❑ COMBINATION �xBU�LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER M�IL�COPESS Gltt 21P P�IOIIE <br /> eoyden Realty, lnc. 1429 eroadway Everett 98201 252-1166 <br /> LRCNIIECIONDESIONER MML�ODRE59 Cltt ZIP PIION[ <br /> Cary Parkinson 527 Med. Dental 61dg. Everett 98201 252-2153 <br /> GENER�LCONIR�CIOH MAILADDRE45 CIIY 21P PNONE UGENSE• <br /> J 6 D lSuilders 1429 6roadway fiverett 98201 252-116G 223-01�* <br /> MECNSHIULCON1MClOq M�ILADDRE54 'CIIY ZIP P��ONE ULef.iE• <br /> ** JD6UI223J0 <br /> CWMOINGCONIR�CIOR M�IL�OPHESS CIIY 21P FIIONI UCENSE• <br /> I�illside P1umULng 13412 - 60th Dr. S.i?. Everett 98201 337-2294 <br /> CU.;�OF WOPK <br /> I� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT ❑ BUILDING RELOCAliON <br /> vei uenoN or won��cost Or uerznuts a�•,i�eow <br /> Ll-s96ff �� 000 � <br /> oes.:nioe wonK <br /> Single ramLly Residence - 2'lan A <br /> usc or emiou+c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> SFR PLICATION AND KNOW THE SAMETO BE TRUEAND CORRECT.ALL <br /> LE4�l0E5GRIPIIONOFP110PEfiY�5110WNBELOWOR�TTACNFOUHCOP1E51 PROVISIONSOFLAWSANDORDINANCESGOVERMNGTHISTYPE <br /> Swirid e Div. 2 OFWORKWILLBECOMPLETEDWITHWHE7HEHSPECIFIEDHERE• <br /> ioi 31 o�oc�—or INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL TI1E PROVISIONS OF� <br /> ANYOTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION <br /> OR THE PERFOHMANCE OF CONSiFUCTION. <br /> SI�NATUREOFCONTRRCTORORRUiHOR12E0AGEN1 OAfE //� <br /> T'- /3 - �� S- X�/ �'- i-� <br /> PROJECi�OUPE55 APP4GANT5 CIiY BOSINE55 LICENSE NO. <br /> 9416 - lst Drive S.G. , Everett <br /> PLUM61N0 MECHANICAL <br /> ryp, TYPE OF FIXNNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF ClOSET TOILET) O AIR COND.UNITS—H.P.EA. <br /> _L BATIiTUB OO AEFRIGEPA710NUNITS—H.P.EA. <br /> LAVAIORYIWASH BASINI OU BOILEFS—H.P.EA. <br /> SNOWER O GAS FIiiEO AC.UNITS—TONNAGE EA <br /> KITCHEN SINKB f715P. � 00 FOflCEO AIR SYSTEMS—B.T.U. M EA. <br /> OISHWASHER 0 WALL HEATEP.S—B.T.U. M <br /> LAUN�A�THAY � UNITHEATERS—B.T.0 M <br /> � CLOTNES WASHER EVAPORATIVE COGLERS <br /> WATER HEAiER � CLO7ME5 DRYERS _ a <br /> UPINAL VENTILATION FAN OD <br /> DRINKING FOUNTRIN RANGE HOOD — <br /> F1.00H DRAIN AIR HANOLING UNIT— C.F.M. <br /> r <br /> VACUUM BREANERS STOVE <br /> ROOF DRAINS—RRINLEADEfiS METAL FIREPLACEB CHIMNEV _ <br /> SINN SEFVICE—BAR.EIC. WOO�STOVE/FIREPLACE�NSERT <br /> SUB TOTAL SUB T0Tl1l S OO <br /> PEflMIT S PEflM1T S _ <br /> TOTALFEE 3 TOTALFEE S Od <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fPON15ElB�LK R[�BSEIBeCK SIOESElOACK PIANGNECNNUMUER <br /> PIAN CNECN FEE <br /> , /�' � / 'S� r¢c �. .v iacceirrNo. <br /> IV ] <br /> USEIONE ��� ���� y�L NTGItE FEES V�LU�TION FEE <br /> PRo �96v± -�'S oNo <br /> ttPl'OfCON`St' Of:COP�/JNCYGqROUV NO.OF�ELLINOUNILS <br /> ��/7 /1^ J DUILDING f C �U <br /> SIZC Ot l�0 NO OV"StORIES Me%.00�AO <br /> ��Z •R3 / PLUMOIN6 � O �� <br /> MECHANICAL �0 <br /> FlRE SPRINKLERS REOUIFEO ❑YES LT�O oiHER <br /> PENA�TY <br /> •PPLIC�LON�GC BY PLANSCnECNE00V �PFl1.FORISSUANLE9Y o p' <br /> 'fOTAL pC / 0 5� <br /> J�� <br />