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r.PPLICATION FOh �,�,�„ <br /> «`«'°'"" CONSTRUCTION 0 <br /> everett PERMIT <br /> BUILD�NO DEPARTMENT TO BE COMPLETED IN INK• PLEASE PRINT <br /> 269•8810 <br /> ❑DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SI6N <br /> OW�IER <br /> M�II�DORE59 Cin br FNONE <br /> �,( C,� i�' L- i"i �' /��C i��� . .i � inu��•�" �.i,' ,.•c,,- <br /> �MCM��FCfORIlkS�UbLN MNl�U0NI5v ���� � <br /> n II <br /> /l <br /> �IfYFMALCOHiO�GiOR M�II�fIDf1E39 Glry lll` �'PON( t�Cl4it • <br /> ��S"' �v`j A)/1fJ �.i /'��� /C� i_C'. Z_ /��!- %- '-) /l�C'��(//�/S�/�/(� ' i'���/i s i��S:J�, i=irV-'..'i�)�/ l i i'I/, <br /> �1fC1UN�L4C N1R1CfOq IA�IL>ODRLSS CIIY ) PllOyf. IICI•IG( • <br /> �l ,] <br /> � <br /> VWMSINOCO�tlRK.lU11 M�II �Db11E53 G�IY L�• 1'11pNf 1IC1491 • <br /> .) <br /> � , <br /> f��i$O�WOuv r� <br /> ❑ NEW ❑ ADDIiION ❑ AL7ERA710N W� FIEPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRFL.INSERT ❑ BUILDING RFLOC��1011_ <br /> vnu�nou or v�ouy�r.osi oi rsa n uui s�� us i.�nom <br /> ��•ti l ' )': • �]� <br /> m scnmc won. � <br /> i <br /> � 1 .C' �(r l� 't' J �(.'i i '— <br /> uscor ewiouw I IIEREBY CERTIFY THAt I HAVE READ AND EXAMINED THIS AM1 <br /> /��^!� /I PLICAlION AND KNOW THE SAME TO BE TRUE ANDCORRECI.ALl <br /> itn+iorsCmm�nN���vnor�mri5��owrvBuowan����crnouncorves pqOVISIONSOFLAWSANDORDINANCESGOVERNINGTNIg1YPE <br /> �r�� �„�����r_i.. : ./ �r.ct+•�. . /�� /a`:.5 � OFWORKWtILBECOMPLETEDWITfiWHETHERSPECIFIEDHERE <br /> im_e�otn—or IN OR NOT.TH�GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUT110RITY TO VIOLATE OR CANCEI THE PROVISI(1N5 OF <br /> � �•�� �-- ,- - � ��•t' � �.^ � - -� /j/, •c 1 .( ANVOTHERSTATEORLOCALIAWREGULATINGCONSTHUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGN�IU C O�CONtRAC10R OR AUi110RIIED R^vENI D4IE <br /> '-L� t: <br /> X .G /� )� j-�� - $P, <br /> OROJECI�DDRE55 •CPII.�NL CI BUSINESSUQ RSE NO <br /> / U ' ' S� (['�%:'.'e :-'1. <br /> PLUMSINO MECHANICAL <br /> NO. TYPF Oi FI%TURE OR ITEM FEE NO. TYPE OF EOUIO!'�Ni FEE <br /> WA�EA CLOSET�TOILET) AiC-AiHN�LC UNITS-H P <br /> B�TMTUB REFNIGERATION UNITS-N P.EA. <br /> UVATOAY IM'�SM OASIN� BOILEAS-B.T U/1f P <br /> SHOwEIi CAS FIPED AA.UNITS-B.T.U. <br /> KITCNEN SINK 8 DISP FORCED�IR SYSTEMS-B.TL. M EA <br /> DISHW�SHEP WALLHEATERS-B.T.U. M <br /> UUNDRY TP�Y UNIT HEATERS-BS.U. M <br /> CIOTHE5W�5HEA EVAPORnTIVCCOOLERS <br /> U�WAL CLOTHES DRYERS <br /> ORINNINO FOUNTAIN VENTILATION FAN <br /> iLOOA ORAIN RANGE HOOD <br /> B�CKFLOWPREVEHIE�S - w�TERHEATER <br /> ROOF�/1�INS-tlAuilEA�ERS '- wOOD STOVE <br /> SINK ISERVICE-d/��.ETC I METAI FIREPLACE 6 CHIMNEV <br /> FIREPIACE INSERT <br /> HEAT FUMP <br /> GA$PIPINO <br /> � ExMPUSTF�N <br /> SUSTOTAL ! SUSTOTAL <br /> PERMIT f V[RMIT <br /> TOTALFEE S TOTALfEE <br /> ���W��SEIB�f.r n[�n5E�9�CK Si�E5E1B�C� �'�aNCI .CNNUMO-E7R FEE � NECEIPTNO. <br /> � . S� �� �'I� ! ( �� y�J�� �S <br /> us� ro��t �"�°"��^,5NR'� v�urn sne FEES VALUAfION FEE <br /> /C_ Z �/7'� UVES�f] �' . <br /> BU�LOING $ �'` 'i C•� <br /> M1�E�€f.Y51 OCCOf'�NCYGROUP NOOFOWFLLINGUNIIS <br /> (/ � N � �� �. %.UMBING <br /> 54E O�Btna N�) Vr S�DaiES M�R oCc �oeo MECMANICAL <br /> �� � <br /> OIIIEP <br /> FIRE SPRINN�ERS REOUIRFU ❑ YES ❑ NO S7ATE BUILDING SURCNARGE � ,J �.. <br /> STATEENERGVSURCMARGE <br /> a�����n;euon�;re� �'�n•+:���CercEoer errnroni55uenLEer ppBLICWOfiKS <br /> �r'� � ,•, . 1 -- -—_ <br /> ��,1� �41�L TOTAL �� i �.�� <br /> PROPEATV OWNEfiS ARE RESPONCIBL[FOR DETER�IININO�ll. <br /> PROPERTV LINE LOCATIONS AND RELNED EASEMEMS. <br />