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APPLIC�„f10N FOR C09VSTR1�.:TION -� Z 3`J (o <br /> PERMIT <br /> Me[ve�Orenn rvcrcli1 <br /> GTY OF A I <br /> everett � <br /> BUILDING DEPAFiTA1ENT • <br /> 259�BBt0 TO BE CnMPLETED IN INK— PLEASE PRINT <br /> OWNER M�R�OOBC55 GIIY 21P IY�ONC <br /> 8�-� P�ei_I��u '�`FD U�ew R�1� f�r. ����1�L 25�' Co21 S -- <br /> IEN�NT M�ILAO��C55 C11Y ZIP P��ONE <br /> M1�NIIEGTOR06PNCF MAILAO�AE55 GIIY 21P �NONE <br /> GENER4lCONiBALTON MAR�DDHE55 CILY SiP PMONE L�CENSE• <br /> MECIIeNIGLGONtR4CTOP MMIMOHE55 CILY IIP PHONE LICEHSE• <br /> PLLIMB�NOCO LRALi� �� ���i���' �1 ��'��1��� <br /> �ESS CIiY ZIP PHONE LIGENSE <br /> a•ss or wor,K <br /> ❑ NEW ❑ A��ITION AITERATION ❑ REPAIR ❑ DEMO�ITION ❑ WOODSTOVFJFRPI INSEHT ❑ BUII�ING RELOCATION <br /> TEN�NIIM�PWEM[HTORINTERIOrPE, O�CIJHIY GONi�GiPER50N�NOPNONENO <br /> GONiN�LT PR�CE O(WORK <br /> OESLFiB�E M.yONN'�H�O S�OU�R[i00I�GE INVOIVE� <br /> ��_�.-''_(�l�_ I'1c-tC� � L.��lfCY <br /> raorc.eo usc o�aunoi ' 1 HEREBV CERTIFY THAT I MAVE READ AN�E%AMINED iH15 APPLICA710N AND <br /> �P KNOW THE SAME TO BE TRUE AND COFRECT.ALL PROVIS�ONS OF LAWS AND <br /> ��.J ORDINANCES GOVERNING 7H15 NPE OP WORK WILL BE COMPLETED WI7H <br /> LEG�l0E5CRIPT10N0 NOVEPTYISnOwNBEIOWONATTAGNfOURCDRE� yyHETNERSPEGFIEDHEF°INORNOT.THEGRANTINGOFAPERMITDOESNOT <br /> PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE 7ROVIS�ONS OF <br /> lpt _ BLocrc OF ANYOTHERSTATEORIOGALLAWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZEO BV THE OW NER OF <br /> qNIDIPC�OMP Y1WTHRTHE STATE CON7RACT/O SHlAWL1B2T7ORC\VMAND <br /> 296200 WAQ � <br /> SIG AEOiCONTRACTOROR U OPIL �GCNT DA"E <br /> �� / �"��� <br /> %IpJEGT���AE55 P�LIGYiSG�LY9U51 IGEN �NOBUSIN?CSN\ME / <br /> l�iEv�l i �ri <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM <br /> FEE NO. TYPE OFEOUIPMENT FEE <br /> WATERCLOSETfTOILEq _ WC—A/MNOLGUNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T. EA <br /> LAVAiOAY(WASHBASIM UNITHEATEFS—BS.U. M <br /> SI{OWER CLO7HES�RVERS — <br /> KITGHEN SINK 8 DISP. VENLILATION FAN <br /> DISHWASHER RANGE HOOC <br /> LAUNDRYTRAY WATER HEATER __ <br /> I CLOTHES WASHER __ �'�'�D STOVE _ <br /> URINAL METAL FIREPLAi:EB CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSEFT <br /> FLOOR ORAIN HEAT PUMP <br /> BAGKFLOW PREVENTERS GhS PIPING <br /> ROOF DFAINS—RAINLEADERS E%HAUST FAN _ <br /> SINKISERVICE—BAR EiC) <br /> SUBTOTAL S SUBTOTAL § _ <br /> PERMIT S PERMIT 5 — <br /> TOTAIfEE S TOTALFEE S <br /> FRONTSEfBALR REARSETBPGK SIOESETBAGK <br /> PUHCNECKHUMBEN FEE NECEIPTNO. <br /> uSEiOHE toTAaen MGANi51TE FEES VALUATION FEE <br /> ❑YES ❑M� <br /> BUILDING <br /> lYpEOLfANST. WCUP�NGYGROUV NOAFDWEIIMGUNIiS <br /> p��pwABIE/�cTu�l pLUMBING <br /> szeove�o� NOAFSI0RIE5 BSMT. OCGLO�U MECHANICAL <br /> ❑v <br /> ❑N <br /> _ NEIGHTlIM1i�T10N OTHER <br /> �ine SP�+�NKtensnEouwEo ❑ves ❑rva STATE BUILOING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> pPPIIGALIONPGGOY RANS�PFRBY PUBLICWORK$ <br /> TOTAL <br />