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� .PPLICATION FO1. ' ���,�„ <br /> ' '"'`"'°"'" CONSTf�l1CTION O <br /> pry�. <br /> everett PERM1�' <br /> BISILDING DEPARTMENT <br /> 239•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑ COMBINAT�OW ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEF M�IL�OOHE55 C��1' / ZIP� j PHONL. <br /> �MJ. � � ��/ A � �'/G .L�P t� ���i (Ir^5�� 'yy Fi.L:1cl� C,C/N� 1'Y.�. �i►�=r'i ,:1.:y'- v:.� <br /> 1RCHIlELIORUtS10NEP M11L�DDRES3 C T P O!C <br /> OENEP�LCONfR�CfOP M�II��ORC99 Citv SO• o��OH[ LiCEN�E• <br /> MEGN�NIf.�lCON1qILTQN / M�ILe00HEY5 ./ Ci�v L�P PnONF UCf��RF <br /> ��AT��'d / ( ���c // -i.� '7 �/.'��.. r'�i-�tLEL�-"l�— .'��•`79 n /:t�[LF.G'G� is;iLz <br /> IUM�INIIUJNIN�l1(1H M.�I1.11UPI14H_y� 1:11Y IIP PIIUNI I�CIN!il <br /> C��SYO�WOP� <br /> ❑ NEW ❑ ADDIT�ON � ALTEPATION ❑ HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RElnC�1lON_ <br /> WLV�Pnu o�won.�cOsr Or bar���uls nLu3 L�Bon� <br /> ��4YJ s� — <br /> oeseaiee woa. <br /> • zr, . <br /> usE or evao�r�c � I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED TFIIS AF- <br /> ���� PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> IEO�LOESCRIn�iONO�PAOPERInS��UWNBELOWOP�I1�CNfOUPCOPiE51 PqOVI510NSOFlAWSANDORDINANCESGOVEfiNINGTHISTVpE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �o�—e�oc�—or IN OF NOT.THE GRANTING OF A PERMIT DOES NOi PRESUME TO <br /> GIVE AUTHORIiYTO VIOIATE OR CANCEL THE PFOVISIONS OF <br /> ANV OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIONANFE O�CONTP4CTOR OR All 10lI12ED 4CENT OntE <br /> X � a, - �--,�'1C <br /> PPOIECT�DOAESS �PFIIC�Ni:CI 'BUSINE534CCNSENO <br /> .'(�- / .�f <br /> PLUMOINO / MECNANICAL <br /> NO. TY7E OF FIXTURF 0111TEM FEE NO. TYPE OF EOUIPMENT FE! <br /> WATER CLOSET�TOILET� A/C—A/HNOIO UNITS—H.P. <br /> BATNTUB AEFHIOERATION UNITS—H.P.Ell <br /> UVATORY�WASM BASIN� BOILERS—B.T.U./M.P. <br /> SMON�ER GAS FIRE�A.C.UNITS—B.T.U. <br /> KITCHEN SINN d OISP FORCEO RiR S�STEMS—B T.U. M EA <br /> DISHWASNER WALLMEATENS—B.T.U. M <br /> LAUNORVTRAV UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORIITIVE COOLERS <br /> UA�NAL CLOTHESORV�RS <br /> DRINNIN6 FOUNTAIN VENTIUT�ON FAN <br /> FLOOR ONAIN RANCE HOOD <br /> BACKFLOW PREVENTE�S WATER HEATER <br /> ROOF ONAINS—RA�N�EAOEFS N'OOD STOVE <br /> S�NK�SERVICE—BA0.ETC� METAI FIqEPUICE 6 CHIMNEV <br /> FIREPLACE INSERT <br /> HEATPUMP <br /> 6AS PIPING <br /> EXHRUSTFAN <br /> SUDTOTAL f lUSTOTAL <br /> FERMIi S �p�T <br /> TOTAIFEE f TOTALFEf <br /> fRf1HI5EIB�f,N NHASF�BACK 9�[SETB�GK �pNCMECKNUMBER FEE RECEIPTNO. <br /> usF LnHE �.��^"�" V�CAIR SIIE FEES VALUATION FEE <br /> ❑vE5 t]NO 5 <br /> BUILDING <br /> r�nEO�[0Y51 OCrppANCYGROUP NOOFOWFLl�NOUNITS <br /> PLUMBING <br /> 5¢E o�BiDa nn ui StoaiEs M�x OCc La�D MECHANICAL <br /> OTHER <br /> FIHE SPRINKLERS REOUIRED L] VES ❑NO STATE BUILDING SURCHARGE <br /> S7ATEENEPGVSURCHARGE <br /> n�vY�f,t1iON�G�: Or �9�i�sCnF.LN[O9Y �PFR �OOiSSWNCEPV <br /> PUBLIC WORKS <br /> T07AL <br /> PROPERTV OWNERS ARE FESPONSIBLE FOR DE7ERA11NING ALL <br /> PROPERTV LINE LOCATIONS AND RELATEU EASEMENIS. <br />