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�� APP �LlCATION f�R � ��r,�n <br /> f�s ErerO�Nn Lp N ST R U CT I O N � <br /> CITY OF <br /> everett PERMIT <br /> TO BE COMPLE?EO IN BLACK INK— PLEASE PRIN7 <br /> BCILDING DEF`T. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> Uw��' MAILA�ORESS civ zm rnor�e <br /> � � I ��r,.,-� �n„)pi)ie l �1��2�T `�820.3 7.�''.Z5�-/777 <br /> �` i ziP r o�e <br /> �pp11�GiO�0E90N[R M�ILADOPE55 ��t� <br /> G[�1L�41C0�+'��CiON MAILPDDBE55 Llrv ur 1'110��[ IICEIlS[• <br /> �N�� ��t,�dsc34in1 � <br /> MCCII�NIC�LCONIRAGI00 MAILRDDRE55 <br /> CILV ZP P OIE LC[ SC <br /> vLUlA0w6COHiPnGlOf1 MnIL�00HE55 CIIY 2iP �MON[ UCCNS[• <br /> LL�SS Of WOI1N <br /> � NEIV ❑ ADDIiION ❑ ALTER�TION ❑ REPAIF ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSER7 BUILOING PEIOCAT�ON <br /> W 1U�11011 Gf WOf1K�LOSi Of MAl[f1UL$PWS LADOR� <br /> , � �Z ��X) • 1 <br /> oescnme xon <br /> >;�,j lvARel�lo�tS` '��Lc� <br /> useor emiou+a I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED lHIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECi.ALL <br /> i.ccni oescmruoN on•nor[rarisiawru oe�aw on ni�nCn FOuncoviesl OF WORKOWILOL BE COMPLETOED WITH WHETHOER SPECIFTED HERE• <br /> w�—eioc�—or — IN OR NO'.THE GRANTING OF A PERMIT DOES NOT PRESUME 70 <br /> GIVE AUTIIORITY TO VIOLATE OR C�NCEI THE PROVISIONS OF <br /> -�Fl _ ���k pz�� _ p�l ANYOTHERSTATEORLOCALLAWREGUTATINGCONSTRUCTION <br /> _ OR THE PERFORMANCE OF CONSTfiUCTION. <br /> ` �I�/-1 C1 S SIGNAIURG OF CO�N7�AL70R OR A i110RIZEU�GCNI on�e <br /> •J t �� ��� Iv�S� �' C �iC�� ��� '� � '1� �� <br /> � X ('c� ��' <�.-6 w., `:.�(� �oJ«c s; <br /> 5 � L�` r pP�L�G�NT5J�1t 9115iNE5SUGEN5EN0. <br /> raoJ[crnoones5 � <br /> ;�$ �- 1' Zh ' • <br /> MECHANICAL <br /> PLUMBINO _ 7rpE OF EOUIPMENT FEE <br /> � NO. TYPE OF FI%TURE FEE N�• <br /> WATER CLOSET ITOILEn O AIP CONO.UNITS—H.P.EA. <br /> � REFRIGERATION UNITS—N.P.EA. <br /> BA7HTU8 <br /> 2 LAVATORYIH'ASNBASIN� 00 BOILEHS—H.P.E�. <br /> GAS FIRED AC.UNITF-70NNnGE EA. <br /> SHOWER <br /> KITCIIEN SINK 8 DISP. FORCED AIR SYSTEMS—D T.U. M EA <br /> WALL HEATEfiS—B.T.U. M <br /> ' DISHWASHER <br /> ' LAUNDRY TRAY UNIi HEATERS—B.1.U, M — <br /> CLOTHES W�SHEA EVAPORAiIVE COOLERS — <br /> 02 CLOTNES DRYERS — <br /> � WATER HEATEH <br /> VENTILATION FAN — <br /> U(71NAL <br /> DR�NKINGFOUNTPIN _ _ RANGEHOOD — <br /> AIH HAN�UNG UNIT— QF.M. <br /> FLOOR DRAIN STOVE <br /> VACUUM 0�[AKERS <br /> ROOF ORAINS—�AINLEA�ERS METAL FlREPLACE 8 CHIMNEY <br /> SINK SERVICE—DAf1,ETC. WOOOSTOVE/FlREPLACEINSERT —. <br /> ^ SOB TOTAL O OO SUB TOTAL S <br /> PEHMIi : <br /> PERMIT : f <br /> ' TOTALFEE 3 O � TOTALFEE <br /> � THIS PORTION TO BE COMPLETcD BY BUILDING DEPT. PERSONNEL <br /> p�RN GNECN NUMBER PLPN CIIEGR f EL <br /> IP@115EIOACN ��EARS[IORLN SIpE5Ei9RCN 55 qECEIPINO <br /> 85 �15�i7 ��� I(�0 ���oo <br /> US[lONE LOi�RER yALANfSrtE FEEB V�W�TION fEE _ <br /> DYES �NO <br /> 1vP[OfCON51. OCCUPANCYGf10UP NO.OFOWELLINQUNItS ' /J <br /> v � BUILOING s � 06d G� I � U <br /> Sii[Of BI�G NO OF S10RIE5 MR%.OGG.lOAO O 0 <br /> PLUMBIN6 U <br /> � MECHANICAL <br /> FIRE SPRINKLFRS f1E0U117CB O YES ❑ NO OTIIER <br /> PENALTY <br /> �PPIICAl10N�Cf, OY PlAF5C�IELN[06Y AVPRfORISiURNCEBY q ��J vo <br /> TOTAL �•. � <br /> «� wt <br /> � <br />