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�:.�? �� ,;� j"; <br />��.E�.,o,,,� A�PLiCATION FOk=`� �veren <br />�,n�F CONSTRUCTION O <br />everett PERMIT <br />BUILDING DEPAP,TMENT <br />259-881� TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION �,BUILDING ❑ MECHANICAL �l9 PLUMBING ❑ SIGN <br />OWNEfl M�IlA00HE5° Cltt ZIP P110NE <br />%' . _ _ ., �1. �e/.e,��c /'GA�I �d�PWd�i /'�.5.. G�ut,e?y 9g2o3 c��3 ^�.�/>B�� <br />OROESi6NEN M�IL <br />��, (J Il <br />ONTRRCTOR MFIL <br />� / <br />/_- -o, `F e �.' .,., � . � 2. s <br />G] <br />C <br />IAECN�INIGLCONiR�CTOfl ( MI11lhUUHlaa ""• '•• .••�••` 7T I7�/ SQCO <br />P.UMBINGCONTflACTON MAILADDRE55 Cltt ZiP PNONE LICEtISE• <br />NEW ❑ ADDITION ❑ ALTERATION ❑ iiEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION_ , <br />TION OF WONM�COST Oi MRTENInLS PLUS LABOPI <br />.� �.. .n -+� �—� la 9. ✓�lo � �� � <br />�v P <br />LOt�� BLOCK_OF � � <br />�� 4 T cL J" 'e � <br />PflOJECi�ODNE55 <br />-7iDq Gawer <br />PLUMBING <br />TYPE OF FIXTI <br />WATER CLOSET (TOILET) <br />BATMT48 <br />UVATORV (WASH BASIN� <br />SHOWER <br />NITCMEN SINK 8 �ISP. <br />OISNWASHER <br />LAUNORVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� <br />� <br />PPEVENTERS <br />�5 — RAINLEAOERS <br />CE — BAR. ETC.) <br />FEE <br />SUBTOTAL s <br />PERMfT = <br />TOTAL FEE s <br />RE�NSETB�CK SIDESETflACK <br />' ' 6� <br />2� <br />LOTAREA VACaNTSR! <br />ES ONO <br />nccuoaur.vr,aouv NO.OFOWELI,INGONITS <br />ZO/(v � <br />��� � � <br />-3 <br />)RIES <br />�3.0 r <br />.IC� N� BY IPLRNSCMECK� IAPPp FOflIS�UAI <br />/e..� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• � <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AI.L � <br />PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYF` ' <br />OF WORK WILL BECOMPLETED WITH WHETHEflSPEC�FIED HEHE• <br />INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO � <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PR�VISIONS OF � <br />ANYOTHER SiATE OR LOCAL LAVd REGULATING CONSTRUCT�ON <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOP Ofl AUTHORI2ED NGENT DATE <br />qPPLIGNTS GrtY Oi <br />MECHANICAL <br />TVPE OF EDUIPME <br />A/C — A/HNOLG UNITS — H.P. <br />PEFRIGERATION UNITS — M.P. EA. <br />601LERS — B.T.0 MP. <br />GAS FIREO A C. U'7IT5 — B.T.U. <br />FOflCED Alp SVS'fEM.S — B.T.U. <br />WALL HEATERS — BS.U. <br />11N1T MEATERS — B.T.U. <br />EVAPORATIVECOOLERS <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERHEATER <br />WOODSTOVE <br />METAL FIREPLACE 6 CMIMNEV <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAI!ST fAN <br />PLAN CMECK ME <br />8 � �� <br />M EA. <br />M <br />SUBTOTAL S ' <br />PERMIT f <br />TOTALFEE � <br />Z �FEE ^ C RECEIPT NO. <br />3�5� ir���, <br />BUILD�NG <br />PLUMBING <br />MECHANICAL <br />OTHEF <br />STATE B ILOING SURCHARG <br />STATE ENEFGY SURCHAfiGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERN OW NERS ARE RLSPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONSAND R[LATED EASEMENTS. <br />