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m.ewror«� <br />cirr oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />,.PPLICATION FO.. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMiiING ❑ SIGN <br />`� M�II ADOR[55 Cli�' ZIV PHONE <br />oll n�ar+� Lo�z 3��-S��Lvi�. �.it�� E;���^r.-E� Pfl,?c3 .�5�.�-4-YT> <br />�R HI7EGi OR OESIGNER MNII NDOFE55 ��n' f Z�P PHONC <br />GENEPALCONiH1LtOF hlslla0f>RESS C�IV ZiP PI�ONE IILENSE• <br />/� <br />�Yll�i r�e-- <br />MELM�NIGLCONTR�LTOfl MAIL>DOflc55 CIiY ZIV PIIONE L�CENSE• <br />VWMBINGCONiR4GtOR AIAII.ADDRt55 CrtV 2iP PNONE LiCENSE• <br />❑VVNEW O ADDITION ❑ ALTERATION ycy REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/ffiPL.INSERT ❑ BUILDING RELOCATION <br />W lU�T10N OF WORK ICOST OF MAiERINLS �'LUS LRBOlU <br />�'es�,-;../e. rc3�� <br />US�E5�BUI ING / <br />��G. r S d rin e <br />LEG�L UES A�PTION OF PROPERTVISHOWN OEI <br />LOT� BLOCI(_—OF <br />�l� '6a �� , �.i� . <br />PPOJECTADOFE55 <br />PLUMBING <br />. NO. TYVE OF FIl <br />WATER CLOSET (TOILI <br />BATMTUB <br />LAVATORVIWASH BA; <br />SHOWER <br />NITCMEN SINK d DiSP. <br />DISHWASMER <br />� LAUNDRVTRAV <br />' CIOTHES WASHER <br />UHINAL <br />� DHINKING FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW °REVENTI <br />. ROOF DPAINS — FAIN <br />� SINN �SERVICE — BAP <br />OR ITEM <br />� <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME T08E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR GANCEL THF PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTFiUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGN4iURE Of CONIR<CTGR 00 AUTHORIZED AGENT OaTE <br />X ��'...-V 1l , �'.,�, 9 � � -� 7 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPI <br />AiC — AiHNDLG UNITS — HP. <br />REFPIGERATION UNITS — H.P. I <br />801LER5 — BS.U.IH.P. <br />GAS FlHED A.C. UNITS — BS U. <br />FORCED AIR SYSTEMS — B T.U. <br />Wp��HEATERS—B.T.U. _ <br />UNIT HEATERS — B.T.0 <br />EVAPORATIVE COOLERS <br />CLOTHESORYERS <br />VENTILATION FAN <br />qs WATER HEATER <br />.EADERS WOOD STOVL <br />ETC) METALFIREPLACEI 'NIMNEV <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL f <br />PERMIT f <br />FEAN <br />sme oc i nn�� <br />USEZONE ILOiARE� Iyq�pN151IE <br />❑YES 1]NU <br />TYPE OF CONST OCCIIPANLY GROUP NO OF DWEL <br />SIZE Oi BIDG <br />FIPE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />APPIiGAt10NnCG 8� PlRNSCHELNEDBY APPR FOfl15Sl1ANLEB� <br />�� <br />�'� . �1 <br />SUBTOTAL <br />PEPNIT <br />YLAN I:MECN NUMBEN I FEE I NECEIPT NO. <br />FEE <br />BUILOING g <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHANGE <br />STATEENERGVSUflCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPER Y L�INE LOCATONS AND PELA'EfE� E SEMENTfSING ALl <br />