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rn. ewro�..� <br />CITI' OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />"iPPLICATION FO'� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />���Q�Ob� <br />APR - 81996 "n <br />_ . ............ e <br />.... <br />CITY OF EVERET'T' <br />Public Works Dept, <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING � SIGN <br />OwNfR M�IL��ORE55 CIiY 21P PMOHE <br />�XKEL DEVELa'i+lov�f <br />ARCMIL�LfOROlSiGNER MULAODRESS CITY 21P PNOHE <br />M�IL <br />div <br />Ek�� P�st�ri� z/� C�AAµ rz e3ttu.c�,�y�„� 962z� zcr�_7;e. L87 <br />MFC�InN1ULCONTPA�ipq MMle00RE5S CIIY LO i`HOryE LICENSE• <br />GUSSOF WORN <br />I� NEW ❑ ADDITION <br />W W�PON Of WORK�GOST OF MI <br />G <br />/ <br />DESCHiBE WORN <br />(yA•S 6'ilttD Fn <br />use or em�mHc <br />,Zt�Sf atN <br />IEG�I OESCR�oiION O� PROPEHi' <br />PLUMBING <br />❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT <br />C•L'7 <br />BATMTUB <br />LAVATORY�WASHBASINI <br />SHOWER <br />KITCHEN $INK 8 DISP. <br />OISHWASMER <br />LAUN�RYTR�V <br />CLOTMES WASHER <br />UHINAL <br />ORINKING FOUNTAIN <br />F�OOR DRAIN <br />BACKFLOW PREVENTERS <br />qOOF DRAINS — RAINLEAOERS <br />SINK �SERVICE — BAR. ETC.1 <br />SUS TOTAI <br />PERMIT <br />TOTALFEE <br />N�pNlSFiBAGn RE�N SETBA�N <br />USE20NE LOiAqEA <br />fVPEOFCONSf OCCUPANCYGFC <br />5�2EOiBl�G NOOFSiOP1E5 <br />FIRE SPRINKLERS REOUIRED ❑ VES <br />4VP�i�R1101��Cf, BY P�ANSCNECNED <br />�� <br />�av <br />FEE <br />f <br />VAC�NT SITE <br />❑vES �NO <br />NO.OF pWEILING UNITS <br />RPPR. FOA ISS��NGt BY <br />❑ BUILDING RELOCATION <br />I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT THE GRANTING OF A PERAtIT DOES NGi PRESUME TO <br />GIVE AUTrIORITY TO V�OLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN�tURE OF GONTRACTOR OF AUT�ORIZED ACENT �qTE <br />MECHANICAL <br />v <br />A/C — A/HNOLC UNITS — HP. <br />REFRIGERIITION UNITS — H.P. EA. <br />BOILERS — B.TL./M.P. <br />GAS FIRED A�C. UNITS — B.T.U. <br />fORCEO AIR SYSTEMS —8 T.U. �M EA. <br />WALLMEATER$—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVE LOOLERS <br />CLOTMESORYERS <br />VENTIIATION FAN <br />RANGEHOOD <br />WATER NEATER <br />WOODSTOVE <br />METAI FIREPLACE 6 CM�MNEV <br />fIRCPIACE INSERT <br />HEATPUMP <br />GAS PIPING <br />PIAN GMECK NUMBER <br />. 5"i 37� <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BUILDING <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />I FEE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />$ <br />RECEIPT NO. <br />FEE <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMININCa ALL <br />PROPEATV LINE LOCATIONS AND RELATED EASEME�JTS. <br />