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rn. e.+ryr.�n <br />�,n � <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />iiPPLICATION FO� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />���Q�Um� <br />APR - 81996 � <br />_..... ......._........ <br />CI7Y OF EVERETT <br />Public Works Dept. <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW��[P M�IL�DDPE55 GITY ZiP PNONE <br />L'XYF.L TlEVE.Lor'rvl�vf ' <br />AqCnrtEGiORDES�GNEH M�iLADORE55 CItV ZiP PHONE <br />MEGN�NIUI <br />wr� iaG++3 /�olr�'353� <br />VHONE IICENSE • <br />.31� • 7;e- LS7 <br />PNONE UCEHSE• <br />• 73? • �f� � [3EtR�N�A <br />PIIDNE IILEHSE • <br />NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.iNSERT ❑ BUILDING RELOCATION <br />,bn •�Oa = Z� <br />WORN <br />Bu1L0ING <br />LEGaL DES( <br />�m- <br />PAOJEGi�DORE55 / <br />�p/z,r,ut 3`+iD � <br />PLUMBING <br />NO. TYPE OF FII(TURE <br />wATEA CLOSET ITOILET) <br />r BATMTUB <br />Ul �TORY �WASM BASIN� <br />$HOWER <br />KITCNEN SINK 6 DISP. <br />LAUNORVTR�Y <br />CLOTHES WRSMER <br />URINAL <br />DRII'KING FOUNTA <br />FLOOR DRAIN <br />BACKFLOW PREVE� <br />ROOF DRAINS — R/ <br />SINK ISERVICE — B <br />1NONISETBACtl <br />'!nE WNE <br />1Y[`E OF CONST <br />S2E Of �LpG <br />FIRE SPRINKL <br />AVPLICApON �CC <br />PERMIT { <br />TOTALFEE f <br />RE.IRSETB�CK SIOESETBeG <br />LOL�REA <br />V�C�NT S�TE <br />pYES ONO <br />OCCUPANGYGFOUP NO.OFOWEL <br />NO OF STORIES W% pCG LO <br />;IRED ❑ VES ❑ NO <br />PUNS CHECNEO BY APPq. FOR i5; <br />�3 <br />`,av ' <br />7�' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGN�TURE OF CONTRAC70R OR AU�OFILED AGENT �ATE <br />CITY <br />MECHANICAL <br />— A/MNDLO UNITS — N.P. <br />RIGERATION UNITS — M.P. EA. <br />GAS FIRED A.C. UNITS — B.T.U. <br />'FORCED AIR SVSTEMS — B.T.U. �M EA. <br />WALLHEATER$-9.T.U. M <br />UNITNEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CIOTHE5 DRVERS <br />VENTILATION FAN <br />RANGEHOO� <br />WATER NEATER <br />wOODSTOVE <br />MEfAL FIREPLACE A CHIMNEY <br />FIREPLACE�NSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLANI;HECKNUMBER <br />FEES <br />BUILDING <br />PLUMBING <br />MECMANICAL <br />SUBTOTAL <br />PERMIT <br />TOT�LFEE <br />�FEE <br />OTMER <br />STATE BUILDING SURCNARG <br />STATEENERGVSURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />$ <br />RECEIPT NO. <br />PROPEF,N OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY IINE LOCATIONS AND RELATED EASEMENTS. <br />