Laserfiche WebLink
IM EwrprMn <br />cin or <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />k,PPLICATION FO1.�� <br />CONSTRUCTIQN <br />PERI'v11T <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />evrretl <br />e <br />❑ DEMOLITION f�COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�IIPUORE9c CIIv ZIP PIIONE <br />�?tone7�co Onc r9�w nl. yy Nio} $tr+tf�t 9Fl�o 3 St/3 • Szr3 — <br />•NCNIfELtOFOkS�OHEf1 M�R�pORESS CIIY 2ia PNONE <br />5�n�- — <br />GENEMlCONIneGtOR M>Ile�Of1[55 Ci1V lif' �I:C::[ LIGENSE� <br />5A»� CsFoqEr ��s e� <br />MELIIANiGL GONiRedDA M�IL AODRE55 GIY IIP P�IONE IICENSE • <br />PLUMBM�CONIR�C10f1 MML�D��[55 u�♦ ��� rnonc ui[npc• <br />P�,ct,ort Sound 2oZY ln!•Ci9s,no EUCCE/T qP�y a`/3�P53� �K6�5 1'/!a�_ <br />cussor oav <br />� NEW ❑ �D�IiION ❑ ALTERATION ❑ NEPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING F7ELOC�T101! <br />vniw��oN or wonn �cos* or M�tcnuts nius unoio <br />t I `j, Shn <br />oES���et w„�,K _ <br />�S/d� <br />o�cnonEnlv <br />w�Z a�ac�— <br />PLUMBING <br />NT <br />WATER CLOSET �TOILET) <br />BATMTUB <br />LAVATORY �WASM BASIN� <br />NITCMEN SINK d DISP <br />DISMWASMER <br />LAUNDPVTRAY <br />CLOTMES WASHER <br />URINAL <br />ORINNING FOUNTAIN <br />FLOQR DRAIN <br />�ACKFLOW PPEVENTE�S <br />ROOF ORAINS — RAINLEADE <br />SINK ISERVICE — 0/ �7. ETC � <br />VRUNISEIO�CM <br />Zo/ <br />usemnE �7 <br />; '� <br />. rvre or corysi��� <br />V <br />� 512EOfOl�O <br />i 10�71 <br />� FIRE SPRIp <br />l <br />� _. <br />I IACI� iOGR CO'"IE51 <br />I HER[BV CERTIFV THAT I HAVE READ AND EXAMINED THIS AP� <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVEHN�NG THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY 07HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNAIUNE Of CUN11inCtOR OR AUf110RiZ[D �GEN7 b4iE <br />X �� ,� �f�r�( ' <br />;z��' <br />rrur.+r�rscnrouswcssi.icu�si +o � <br />MECHANICAL <br />OR ITEM FEE NO. TYPE OF EQUIPMENT <br />^ NC — A/HNOLG UNITS — MP <br />FEFRIGERA710N UNITS — M P. EA. <br />BOILERS — B.T.U./HP. <br />GAS FIqED A C. UNITS — B T.0 <br />FOFCED AIH SYSTEMS — 0?L. M <br />WpLLMEATERS—OTU. M <br />UNI7 NEATERS — B.TL. M <br />E�APORATIVE COOLERS <br />CLOTMES DRV[RS <br />� VENTILATION FAN <br />RnNGEHOOD <br />WATEP HEATER <br />g WOODSTOVE <br />METAI 1�8PJAH1A�.jD CMIMNEY <br />FIREPLACEINSERT <br />11EAT PUMP <br />G/.5 PIPING <br />FxNAIIST FAN <br />SUB TOTAL <br />PERMIT <br />TOTAIFEE <br />REAR SE16�GN <br />/ <br />7r� <br />IOiARE� <br />f� � 3 <br />occuv�Hcvcaour <br />�� — �.� <br />NO O� S�ORIf:S <br />� <br />PUNS <br />Y <br />� <br />Y <br />� <br />� <br />6 / <br />VAC�Ni511E <br />pTES �NO <br />MA% <br />errn roia �ssunHce or <br />�� <br />PLAN <br />�( <br />� <br />SUBTOTAL <br />VERMIT <br />PEE _ � FECEIPT NO. <br />FEES � VALUaTION <br />sui�oiNc 5 '/�,SOCJ <br />PLUMBING <br />MECHANICAL -- <br />OTIIER <br />STATE BUILDING SURCHARGE <br />STATE ENEPGY SURCHAI9GE <br />PUBLIC WOFNS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PHOPERTVLINELOCATIONSANDRELATEOEASEMEN(a <br />