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I� <br />� <br />fA� Er�rprN� <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ¢( <br />encNrtE`ci o/�n OlS��crvER <br />`I�1��1 <br />�"� <br />A'�'PLICATION FOR � <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />COMBINATION ❑ BU�LDING ❑ MECHANICAL <br />�1 �41l�DDRE55 Li1V )ip <br />l/)�L �1/�l � 3�/ �/7� 4L� ���f/n'� <br />M�IL <br />❑ PLUMBING <br />PHONE <br />,S�/J�J/3 <br />PHONE <br />mwHt <br />eveietl <br />e <br />❑ SIGN <br />/ r% �3�1. <br />Q'Wt��i &��i[' 4G�,�1� (%�i4Ers i4io� <br />' t1�5��7 N'OnK <br />� w NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ D[MOL1110N ❑ WOODSTOVE/FRFL.INSERT ❑ BUILDING RELOCATION <br />.,.�, ...............��....,,.,._.,�..,..,..,,,..,�,.� J LT� <br />�ESCRIB[ WOB'NI A- — <br />/vUn) �wnu C'M�SC !�S ( �- �' �/J �j <br />use or ni.ao�wc <br />�i� �„n� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATION AND KMOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />iec.��oq[sca�avoH000noPennrsrwwr�oeiowonnnnc��rouncoaies PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />wiJJ_o�oc�-or- ��'`� ��J ���'� � OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br />PROJEGI�pOR[55 <br />� � n n <br />PLUMBING <br />NO. TYPE OF FIJ(TURE ( <br />'i WATERClOSET�TOILET) <br />BATMTUB <br />LAVAiORY1WASHBA5IN� <br />j[ SHOwEF <br />NITCHEN SINK d DISP. <br />DISHwASHER <br />IAUNDNV TRI1Y <br />CIOTNES WASMEp <br />URINAL <br />DRINNING FOUNTAIN <br />FIOOH ONAIN <br />BIICKFLOW PREVENTERS <br />ROOF DNAINS - RAINLEAOERS <br />SINK �SERVICE - BAR, ETCJ <br />�BUNfSEIHRCN N[• <br />z� ' <br />�5F ZaN/� ���t <br />n/ ' <br />fYNE OF CON51 OCC <br />i4E Oi ItlD6 NO <br />norv+cc B. <br />Y 1 � <br />SUBTOTAL <br />PERMIT <br />10TALFEE <br />i <br />e�u�cn soESReacrt <br />✓. , <br />� �. <br />E♦ <br />WCANI SIiE <br />C�7�, �;�j ❑YES ONO <br />�NCYGROUP NOOFOW[ILINGUN115 <br />SiORIES MR% OCC LOPO <br />umcrceoor Inapnronissuer�ceor <br />/.�/ Y'�/ <br />IN OR NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION� 7F <br />ANYOTHERSTATEOFLOCALLAWREGULATINGCONSTRU�.-' `N <br />OR THE PEFFORMANCE OF CONSTRUCTION. <br />SiGNR1UR OFCONiRACiGfiOR�UfNOR�ZE�r1GENT pqiE <br />X � —i�f� �(R�r.'�lti �/�l�/�� <br />oruuHr,cnrnusiHEssucv.r+srno i <br />MECHANICAL <br />TYPE OF EOUIPMEN7 <br />A/C — AMNOIG UNITS — H P. <br />REFHIGERATION UNITS —Ii.P. EA. <br />BOILEflS — B.7 UlM P. <br />GAS FIREO A C. UNITS — B.T.U. <br />FORCED AIR SYSTEMS — B.T.U. M <br />WA�LHEATERS—B.T.U. M <br />UNIT 11EATERS — O.T.U. M <br />EVAPORATIVE COOlERS <br />CLOTHESORVERS <br />VENTILATION FAN <br />PANGEHOO� <br />WATERNEATER <br />wOUDSTOVE <br />MET�L �1(�VJ.1(�A CH I MNEV <br />FIREPLACE INSE(li <br />MEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL f �'"''C <br />PERNIT f <br />TOTAL FEE f —� <br />V�An CHECK NUM�ER FEE FECEIPT NO. <br />�a� i �r 3�P� s � <br />FEES VALUATION FEE <br />BUILDING � <br />� <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHApGE <br />i <br />S7nTEENERGVSURCHnFGE <br />PUBIIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCA710NS AND RELAi[D EASEh".ENTS. <br />1 <br />