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�i'PLICARUCTIONh, <br />'"'E~ro'"" CO N ST <br />Cltt OF <br />everett PERMIT <br />BUILDING DEPARTMENT TO 8E COMPLETED IN INK • PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL <br />�MBING ❑ SIGN <br />�' GIIY uv .�..�.. <br />•RCHITECIOROFSipNER MMI.�OORE55 <br />GENER�I CONTN�CiOR MML ApORE55 C�N ZIP PHQNE UGENSE • <br />:L�SS Oi WGRN <br />❑ NEW ❑ ADDITION <br />l[OAL OESCPIP1iON O� oA <br />wr_e�ocn� <br />PLUMBINCi <br />NO. T'PE OF FIXTI. <br />WATEP CLOSET �TOILET) <br />BATNTUB <br />UVATORY IWASH B�SIN� <br />SMOwER <br />NITCMEN SINK 8 DISP. <br />OISHW�SHER <br />UUN�RV TRAV <br />CIOTMES W�SHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOON DRAIN <br />BFCNFLOW PREVENTERS <br />ROOF DR�INS — RAINLEI <br />SIWK ISERVILE — BAA. El <br />PCC 9V <br />AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIIDING RElOCA710N <br />i I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED TNIS AP• <br />PLICATION ANO KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />IOWOR�IiAGNFOURC0�1ES1 pROVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br />OF WOi;K WILL BECOMPLETED WITH WHETHERSPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNAIIIRE Of CONLR4CiQ� OR aU IOf112ED aGENT O�IE <br />/��� �Y/� � �` -� <br />X,, , <br />a�rT� _ , � , <br />APP�IUNiSGI1v8U5�NE5 UGlNSE O <br />! <br />� <br />MECHANICAL <br />R ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />R/C — NMNDLG UNITS — MP. <br />NEFR16ERATION UNITS —H P. EA. <br />BOIlERS — B T.0 �H P. � <br />G�S FIREO �.C. UNITS — B.T U. <br />FORCED AIP SYSTEMS — B T.U. M FA� I <br />W�LL HEATERS — B.T U. M • <br />UNITMEATERS—B.TL M <br />— EVAPOR�TIVE COOLERS I <br />SU! T0Tl1l <br />PERMIT <br />TOTAL FEE <br />r.vi.�i <br />� <br />f <br />f <br />Si�[ SETB�Ci <br />V�C�NT SiiE <br />❑YES ONO <br />� o or owe� <br />Br �ervq <br />iosa <br />VENTIUTION FAN <br />MN6E HOOD <br />WATER HEATER <br />WOOOSTO�E <br />MEfAI FIPEPUCE 6 CHIMNEY <br />FIREPIACE INSERT <br />NEAT PUMP <br />FAN <br />SUBTOTAL <br />PERMIT <br />—� TOTAL FEE �I <br />P�AN CMECK NUMBER I FEE I RECEIPT NO. <br />,s <br />auaoiNc 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDiNG SURCNAFGE <br />STATEENERGYSURCHARGE <br />ar <br />PUBLIC WOPHS <br />TOTAL <br />PqOPERTV L�INE LOCA7�ION5 ANDNRELN EO EASEMENTIS ING ALL <br />... ..._..,..,. .. .. .. ._. . ._ . . .?.., ..�. . . . . . , _ <br />