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r <br /> I '�/' ' <br /> ..-e, �"";.. /� <br /> i c�oro�� �PLICATION FO1� �i/ everetl <br /> CONSTRUCTION ,�� e <br /> � everett PE R M I T <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> , ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �E� ��� MMLADDHE QTY 21P PIIONE <br /> ►-1C1Dl.o-o7��!' �1�PJ11� �►'e�� ���3 �55-�?�1.� <br /> � �qCHITECTUH0E51GNER M11L�OORE55 CIIY 11� PNONE <br /> GENERAI LONiRAL10R M�II nDUfiE55 (:ilv LiP apONE LICENSE• <br /> ' �M9/CN��D1ANT4AC.10�4 `���:J L LM^rJ'�5�.�\""^-i-Cv ��` �I�C-� �J��t I�G� JS��NIJO V1'ILCI�� IG�I��� <br /> � PLUMBINGCO ��'oR MA11.40[lR[$S � C�LV 11� PI10NE UCENSE� <br /> 1 CUSSO�WORN <br /> � ❑ NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIfi ❑ DEMOIITION ❑ WOOOS70VE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALU4TION OF WOFN�GO51 OI'Mat[RIALS i'LUS LABOPo <br /> . D RiBE W0 N ' - <br /> !-�l� . C. C'� csL LvCl:l�11-�1t_¢ �d-Q11, <br /> U¢��� <br /> I HEREBY CERTIFY THAT 1 HAVE fiEAD AND FXAMINED THIS AP� <br /> PLIC�TION AND KNOW THE SAME TO BE TRUE AND CORRECT.AL.� <br /> � LEORLOESC`p�PT��N�FP�OPERTVISHOWNBE�OWORAITACNfOU11COPIE51 PROVISIONSOF�AWSANDORDINANCESGOVERNINGTHISTYPE <br /> . OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE• <br /> ' �oi—e�oc�_or INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CAM10EL THE PROVISIONS OF <br /> : ANY OTHER STHTE OR LOCAL LAW REGULATING CONSTRUCTION <br /> ; OR THE PEFiFORMANCE OF CONSTRUCTION. . <br /> SIGNAIURE Of CONiq4CTGF Ott AULMORIZPD AGENi Un7E <br /> X �� � -/9-a8 <br /> PROJECU��PE55 � APPLiLRNT5Ci1vpUSiNESSU H4EN0 <br /> ' t-Iq (�o- 3'`�` � 1/�I <br /> � PLUMBING MF.CHANICAL <br /> . NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMEN7 FEE <br /> ' WATER CLOSET(TOILET� A/C—A/HNDLG UNITS—HP. <br /> - BATHTUB REFRIGERAiIONUNITS—HP.EA. <br /> � UIVATORV(WASM BASINI BOILERS—B.T.U.M P. <br /> SHOWER GAS FIRED A.C.UNITS—B.T.U. <br /> � KITCHEN SINK A DISP. FORCED AIR SYSTEMS—B T.U. FJ�. � <br /> DISHWASHER WAILNEATERS—B.T.U. M <br /> � UUNDHV TRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHEF EVAPORA7IVECOOLERS <br /> � URINAI CLOTHES ORYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR ORAIN RANGE HOO� <br /> . BACKFLOW PRE�ENTERS WATER HEATER <br /> � ROOF DRA�NS—RAINLEADERS WO00 STOVE <br /> SINN(SERVICE—BAF.ETC.) METAL FIREPUICE 8 CMIMNEV <br /> FIREPLACE INSERT <br /> HEAT PIJMP <br /> GAS PIPING <br /> E%HAUSTFAN <br /> SUBTOTAL f SUBTOTAL <br /> PERMI7 f PERMI7 ' <br /> TOTALFEE f TOTALFEE <br /> f pONT SEIOACh �EAR SEiBACM SiOE SGidAGN PIAN CHECI(NUMBER FEE RECEIPT NO. <br /> ❑SE LUNE LOT AFEA yp[qNT SIiE FEES VALUATION FEE <br /> ❑`ES ONO <br /> BUILDING S <br /> TVPEOfCONST OCGUP/NLYGROUP 40OFDWF.LIINf.UNIiS ' <br /> � PLUMBING II <br /> S12EOFBL�G NOOF:iIORI[S MA%.00CLOnD <br /> MECHANICAL �, <br /> OiHER i <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ t10 STATE BUILDING SURCHARGE <br /> STATEENERGYSURCHARGE � <br /> , � iVVLICA��ONPCG I1Y PLhNSI:NECHEJflY APCR fO015SOANGEDY PUBLICWORK$ <br /> 70TAL <br /> `j; <br /> � PROPF.RTYOWNERSARERESPONSIBLEFORDETEflMININGALL i <br /> PROPERTY LINE LOCATIO:JS ANO RELATED EASEMENTS. <br /> I <br /> l...fg, - . • . . , , . . .� . <br />