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� �r , <br />��,• �'-� ' APPLICATION FO''� <br />°'�'E""""' " ' �' `CO��ISTRUCTION ' <br />'hrpno► '_�+•' . ; .. �.., : <br />' �everett � PERMiT <br />� BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETEU IN INK- PLEASE PRINT <br />� O DEMOLI710N ❑ COMBINATION ❑ BUILDING T�MECHANICAL <br />.�:.Yp�yryEp ,+ M�Il�70RE55 CI ZIP <br />_ ..i�; .-.-�^�-,-' �n _ _ ', rl .�. ! 1, , ✓Yl/�.i`.'nd 1 �.:r, . , , ,%�. <br />tl <br />M�IL ApORE55 <br />21P <br />❑ PLUMBING ��.0 SIGN <br />PHONE . �1. �•.� <br />_ ,_,_ . ..+Y. ��:. <br />PIIONE <br />PHONE <br />� <br />PNONE <br />.ICEHSE • <br />❑ NEW ❑ ADDI710N L�ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL,INSERT ❑ BUILDING REIOCATION <br />yALU�1�ONOFWORNICOSiOLM.11 I�LS WSL�BORI <br />�t �joDD . OJ <br />oe eewonK _ , . <br />r/ <br />PIUMBING <br />' NO. TYPE OF FI; <br />WATEP CLOSET ITOIL <br />BATHTUB <br />LAVATORYIWASHBA! <br />SHOWEN <br />" KITCMEN SINN 6 DISP. <br />CLOTMES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN � <br />BACKFLOW PREVENTEPS <br />ROOF DRI11N5 — RAINL-AOERS <br />SINK �SERVICE — BAR. ETC.� <br />lUSTOTAI <br />PERMIT <br />TOTALfCE <br />RE�RSETBAGN <br />USESONE <br />A4P�IG�iIONALG BV IPLANSl;11ECNEDBY <br />/\ <br />.._�C%�\ <br />� � � <br />SIDE SETB�CK <br />V�C�NT SITE <br />�YES ONO <br />rnex.ocG �oeD <br />FORISSU�NCE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. NLL <br />PliOVIS10NS OF LAWSAND ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br />i1NYOTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OF TME PERFORMANCE OF CONSTRUCTION. � ,, <br />SIG^N�TUREOFCONTR�CTOROR�UTHORIZEDA^6ENT O�TE <br />�L 1 � / { <br />NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />AiC — A/HNOLG UNITS — N.P. <br />NEFRIGEFFTION UN�TS — H.P. EA. <br />BOILERS — B.T.U./M.P. <br />OAS FIRED A.C. UNITS — B.T.LL � <br />FORCED AIR SYSTEMS — B. i.U. M EA <br />WALLMEATEFS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTMESORVERS <br />VENTILATION FAN <br />WOOD STOVC <br />METAL FIREPLACE Q CHIMNEY <br />FIREPUCE INSERT <br />MEATPUMP <br />GAS PIPINO <br />EXMAUSiFAN <br />PCRMIT <br />TOTALFEE <br />PLAN CHECN NUMBER I FEE I RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING 5 <br />PLUMBING <br />MECNANICAL <br />OTHER <br />STATE BUILDING SUACHAPGE <br />STATEENERGYSURCHARGE <br />PUB�IC WORKS <br />TOTAL <br />PROPEPTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPEPTV LINE LOCATIONS AND RELATED EASEMENTS. <br />- �.rr:� ' ' _ - . �, :,� - <br />