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APPLICATION fOR ��e <br /> G Ea'"" CONSTRUCTION 0 <br /> everett PERMIT <br /> BUILDING DEPARTMEN7 TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259-8810 <br /> � �DEMOLITION ❑ COMBtNATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWXEH --� M4.��DDRESS QTY I�P VN04E <br /> ���^ Ti�s 43�Z (Zau�� EVT' 339 - �� i i -- <br /> 1pCNREf.IOROE5IGNER MFiI>�DHE55 Ct ONE <br /> 'S�d_/1G�� <br /> GENERALGONiF�CiOR MNLaD�R[5 Ciiv SiP �G <br /> Bm.,�` �IKT ��. ��• L3bx (o'� Lk� Sfeve�s O�,uici /3G.rr¢ <br /> MECN�NiULCONiR�GiOH <br /> rnu��ooaess ��v z�v rr�or+c ucuise . <br /> PWMBiNOCONiR�GtOR M�R�DORE55 Cih dV PnON( IiCU�SE• <br /> CU55O{WORa <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � DEMOLITION ❑ WOODSTOVE;FRPL.WSERT ❑ BUILDING RELOCATiON_ <br /> WW�TiOdOfWORniGO510fM�iCRIPLS�LUSLABOA� � <br /> DESCRIBE WOPN <br /> � __ — <br /> useovew�o��+c I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL . <br /> �cc.�oesca�rno[�_O�PROPERTYISMOWNBELOWORAIT4CIfOUACOP�ES PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> �OuT�"� r2� ��g�T ddT�p OF WOFK WILL BECOAIPLETED WITH WHETHERSPECIFIED HERE <br /> �Oi�.B�OCn1G-OF IN OR NOT.THE GRANTING OF A PERMIT DOES 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 /> S�GNATUAE O�WNtNnCTGR OR AUTHOFi2ED AGENL patE <br /> X � d 7 -8�S <br /> APPUUN�S Ci�V OUSiNESSIiCEHSE ti0 <br /> PHOJEGI��nOHE55 <br /> .JI ! n C� <br /> PLUMlINfi MECHANICAL <br /> NO. TtiE OF FlXTURE OR ITEM FEE NO. TNPE Of EOUIVMENT <br /> FEE <br /> WATER CLOSET�TOILET� AiC—tiiNNOLG UNITS—M P <br /> REFRIGERATION UNIT$—N P.EA. <br /> BATMTUB <br /> UV�TORY 1W�SM B�SIN� BOILER$—8 T U M P <br /> GAS FIRED AA.UNtTS—B.T.U. <br /> SHOWER <br /> NITCHEN SINK 6 DISPt FORCEO nIR SYSTEMS—B T U. M EA. <br /> DISMN�SMER WALLMEATERS—B.TU. M <br /> UUNORY TRAY UNIT HEATERS—B.T U. M <br /> LLOTHES WASHER EVAPORATIVE COOLERS <br /> CLOTMESORYERS <br /> URINAL <br /> ORINKING FOUNTAIN VENTILATION FAN <br /> RANGEMOOD <br /> FLOON UAAIN <br /> BACKFLOW PRF.VENTERS WATER MEATER <br /> NOOF DRAINS—RAINLEAOEHS WOOD STOVE <br /> SINK�SERVICE—BAH.ETL) METAL FIREPLACE 6 CMIMNEV <br /> FIREPLACEINSERT <br /> HEATPUMP <br /> GAS PIPING <br /> E%HAUSTFAN <br /> W!TOT11L f 4U!TOTl1l <br /> rERM1T f PlIIMIT <br /> TOt�IFEf f TOT�LFEE • <br /> fH0Ni5E1B�CN AE�R SE10�CN $IOE SCiB�CK <br /> pLAH CMECK NUMBER FEE RELEIPT NO. <br /> use ton� LOi AHL� y�LANT SrtL FEES VALUATION �E <br /> 7YE5 ONO 5 <br /> BUILDING <br /> T�"oEO��COv51 OCCUP�NLYGROUP NOOGOWELUYGUNIiS <br /> PLUMBING <br /> SRE o�BtoG HO OG SiOAiES Mnx oLL �o4D MECMANICAL <br /> OTHER <br /> FIRE SPRINKI.ERS REOUIRED ❑�ES ❑ NO STATE BUILfIINIi SURCHARGE <br /> STATEENERGYSURCHARGE <br /> ni�viicanOrv<cr. nv v.n.�s[�Ecx[Dev ercqroai55u�nCeBr pUBLICWORNS <br /> ��� TOTAL <br /> PROPERNL�INELOCATONSANDNREBATEOE SEMENTISINGALL <br />