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i �. <br /> I t�PLICATION FO '�`� ���,�„ <br /> � «E«"� �� CONSTRUCTION O. <br /> I .everett PE RM tT <br /> BUILDING DEPARTMENT TO BE COMPLE7'eD !N INK• PLEASE PRINT <br /> � 259•8870 � / <br /> I ❑ DEMOLITION ❑ :ONIBINATION ❑ BUILDING ❑ MECHANICAL �� PLUMBING 7��SIGN <br /> MAIL�O�AE55 V CItV /] �� 2iP PHONE � �� I / <br /> OWMER ��NI `� �/�K JC///l� �.��1 � l l <br /> i �o..�-( G�i�,�'_ IOcJO l,�f�3�ot-tl �I —+ <br /> j �pGMITECTOROEfiUNER MSIL�ODR[95 Ci�v iio PNONE <br /> 1 I��� _ <br /> � OENEP�ILONiP�G�OR M�R�DOHE55 L V 2 ONk LGENSE <br /> � S� ioN`T-�� � "l�r2/ " ���`�"'-WA�( /� �i��TT(,L //'BIS� 3��'��67 SfGJI�i'4�1$OPJi <br /> � MEGN�MIWLCONTP�GTOq M�IL�ODRE55 Cltt iiP PMONE 4GENSE <br /> � PLUMB�NO CONiFACiOP M�IL ADORE55 CitY Z�❑ PIION4 LICENSE• <br /> �� GV59��WORK <br /> NEW ❑ pDDITIUN ❑ ALTERATION ❑ FEPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPI.INSERi BUILDING RELOCRTiON <br /> 1 <br /> ` WLU�TIONOFWOPK�COSiOFM�IEPUL5PW5UBOA1 <br /> � �K'O O� � �� <br /> �ESCRiBE WORK � <br /> L�D� - �fri� -'�l�v p U ,� S GNQL i c��,Go •:___— <br /> � useoreuaou+a � 1 HEREBY CERTIFY THAT I HAVE (IEhD AND [%AMINED THIS AP� <br /> � PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> ! LEO�LDESGA�PT�ONOFVROPEHlYISNOWNBEIOWON�IT�LNFOVACOP�E51 PROVISIONSOFLAWSANDORDINAtICESGOVERNINGTHISTVPE <br /> OF WORKYJILL BE COMPLETED WIThI WHETHER SPECIFIED HERE- <br /> � io�,B�o��_oF_ INORN0T.7HEGFANTINGOFAPEtiMITDOESNOTPRESUMETO <br /> � GIVE AUTHORITY TO VIOLATE OR ';ANCEL THE F.70VISIONS OF <br /> 9� (�(>, ANYOTHERSTATEORLOCALLAW,IEGULATINGCONSTRUCTION <br /> � _. OR THE PERFORMANCE OF CONS"'FUCTION. . <br /> � s ���� ,� � 2� r S siaw.rua (7FUD�1IR�CTOR OR�UTNORIZEP.:OENT n�re <br /> � j <br /> � _ �_�S <br /> j . c�c; �n-s�' W <br /> FROJFCT�DORE59 �vPLiG�NTSCifY0U5iNE55 �CtN5EN0 <br /> � <br /> 1 PLUMOIN6 MECMANICAL <br /> T/PE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � ' NO. � <br /> WATEP CLOSET�TOILET) A/C—A/NNDLG UNITS—H P. <br /> B�TMTUO REFFIGERATION UNITS—NP.EA. <br /> IAVATORV(W�SH BASINI BOIlERS—B.T.U./H P. <br /> 6AS FIREO A.C.UNITS—B.T.U. <br /> SMOWER <br /> KITCMEN SINK 6 OISP FORCED AIR SYSTEMS—B T.U. M EA. <br /> WALLHEIITER3—B.T.U. M <br /> OISMWASMER M <br /> � U1UN7RYTR�V UNITHEATENS—B.T.U. <br /> GLOTNES WASHER EVAPORATIVE COOLERS <br /> � � URINAI CLOTMESORYERS <br /> { � DR�NKIN6FOUNTAIN VENTILATIONFAN <br /> HANGENOOD .— <br /> � FIOOR DRAIN - <br /> � BACKFLOWPREVENTERS W�TERNEATER ' �. <br /> , ROOF DR�INS—RAINLEALIERS N/OOD STOVE <br /> � SINK(SERVIGE—B�R.ETC.) METAL PIREPLALE 8 CHIMNEV <br /> FIREPIACE INSERT <br /> � <br /> HEAT PUMP <br /> j (iA5 PIPINO _ <br /> � —� E%MAUSTFAN �_ <br /> 1 SUSTOTAI ! SUSTOTAL <br /> � PEPMIT i P[RMIT <br /> i TOTALFEE f TOT�LFEE <br /> ' P�nN CMECN NUMBER FEE RECEIPT NO. <br /> � fPONTSETB�Ct ME�A 9E16ACN SiDE 9EtB�CN <br /> I <br /> I / , • <br /> i <br /> � USE ZONE �or eaee �r,cer�t srte FEES VALUATION FEE <br /> prEs at�o dUILDING SS -" <br /> � TYFEOFLONST . OCCl1P�NCYGAOUP NO.OiDWELLINOUNITS <br /> � , FIUMBING <br /> � S�ZEovBloa NOO�STORIES M�%.OGLLO�D MECHANICAL <br /> I <br /> I — OTHER <br /> � FIHE SPRINKLERS REOUIRED ❑ YES ❑NO STATE BUILOING SURCHnHGE <br /> � , STATEENERGYSURCHARGE <br /> i �YVIIL�iION AGG B� PL4NSl'NECHEO BY �PPR.FOf1195UANLE 0Y p�BUC WORKS <br /> � � /( � TOTAL v" <br /> � �.J�i <br /> PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMININO AlL <br /> PROPEfiTY I.�NE LOCATIONSANO RELATED EASEMENT9. <br /> � <br /> I <br /> ' .�,.-J 5�.. :..'F"1I1.1;'.' _ .... �,-;� . <br /> ....._.....� ....- .��_ ._.__ . r�:':11^P.i_E"�. <br /> .1l�f^yp.�a•.ni^..'Tf:f�R.�.��. i-. .� �:�. ' . . . . , . . <br />