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r ` ( / <br /> ':PPLICATION fOi� �' ` 1"� <br /> everetl <br /> '"'E"`°'"" CO N ST�R U CT I O N e <br /> an oF <br /> everett PE RM IT <br /> BUILDING DEPARTMENT TO Bc COMPLET�D IN INK • PLEASE PRINT <br /> 259•8810 <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING �MECHANICAL C' PLUMBING ❑ SIGN <br /> MRII ADDHES$� GIIV LIP P ONE <br /> �E�� Mtll�.� �-1R(0 -�3k-° �Vl� t/�l �zeY2�.l �$10� ��7�-�xx.o.C� <br /> �HCMITlGi0RUk5�GNER MnILRDOPFSS CIV ! N ONC <br /> GENEFALCONIFAGTOR MML/�ORESS Grv 111' PHONE LiCENSE+ <br /> CM�NICPLCONTNPCiOq MnIL400AE5 CIfY ZIP �IIONE LIGENSE• <br /> ��n � 1 � � � �1n� L �C.�S �I�?� �-�t'Qlu�x�.�i� �1�i �r��� aP��l ���� �V#�L�7 <br /> PLUMBING CO� R�CiOR MAIL RDDR655 C lY Z P AI,ONE LICENSE• <br /> CL�SS O�WOPN <br /> � ❑ NEW ❑ AOOI710N ❑ ALTERAT�ON ❑ REPAIR ❑ DEMOLI110N ❑ WOODSTOVE/FFPL.INSERT ❑ BUILDING RELOCA710N_ <br /> wtuerioN or wonnicost nr�dn�uaa�s r�us i.nunni <br /> D�SGPIBEWOPM �7�`�) -�L��M�,� 1 U �IL�� �n n <br /> '��'L����.�.�— l�L�t_(�C11CL�-� `1 � ` � `_c.�.�`.�� - <br /> use o�i�� I NER[BY CERTIFY THAT I HAVE READ AND EXAMINEU THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TFUEAND CORRECT.ALL <br /> lEOAIDESCPIPTIONOFGqOPERTVISHOWNBELOWURP1iAGNiOURW�IE$1 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WNETHEFiSPECIFIED HERE• <br /> io�—e�oc�—oF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT FRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL ThiE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL I_AW REGULATING CONSTRUCTION <br /> � OR THE PERFORMANCEI^'OF GONSTFUCTION. . <br /> SIGNATUPEOI"GONIR CIO�Qq�'�fHO�iIZEOAGENT DaTE <br /> � � �� <br /> X ' ��C/�� n�.d �`��` <br /> � PROJECT�OORESS � " � APPIICANi5CI1V6U5���E55liCtu5Eb0 <br /> L�G 1�"��J�� �'�l� V�l <br /> PlUM81NG MECHANICAL <br /> NO. TVPE OF FI1(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . W�TEH CLOSET(TOILET� A/C-�A/HNpLG UNITS—MP. <br /> i <br /> BATMTUB PEFRIGER:�TION UNITS—H P.EA. <br /> UVATORY I�'�'ASN BASIN� BOILERS—B.T.0 MP <br /> � SHOWER GAS FIRED AA.UNITS—B T.U. <br /> ' KITCHEN SINK b DISP. FORCED AIR SVSTEMS—B.T.0 G�M EA. <br /> � DISIiWASHER WA��HEATERS—B.T.U. M <br /> � ' LAUNDRV TRAV UNIT HEATERS—BS.0 �� <br /> I CIOTHES WASHER EVAPORATIVE COOLERS <br /> - CLOTNESORYERS <br /> � URINAL <br /> DRINKING FOUNTAIN VENTIUITION FAN <br /> � FLOOR ORAIN RANGE HO00 <br /> BACKFLOW PREVENTERS WATER HEATER <br /> . ROOFORAINS—AAINLEADEPS WOO�STOVE <br /> SINK ISEFVICE—BAR.ETC.) METAI FIHEPLACE 6 CHIMNEY <br /> � FIfiEPIACE INSERT <br /> MEATPUMP <br /> . GAS PIPING <br /> EXHAUSTFAN <br /> SUBTOTAL f SUBTOTAL <br /> PERMIT S GENMIT � <br /> TOTAL FEE S TOTAL FEE <br /> ' 1'LAN I;HECK NUMBER FEE RECEIPT NO. <br /> fRONTSETBRCN AERR$Ei9AGN SIDE SETBNCK <br /> use zonE LOi AREA yppqryT$IfE FEES VALUATION FEE <br /> OVES ONO S <br /> BUILD�NG <br /> ttPEOFCON51 OCCOPnNGYGROUP NOOFDWFLLINf.UNITS <br /> PLUMBING <br /> SIZE OF PlDfi NO Of SlOR1ES Mn% OLG iOAD MECHANICAL <br /> OTHER � <br /> FIfiE SPRINKLEfiS REOUIRE� ❑ VES ❑ NO S7ATE BUILDING SURCHARGE ' <br /> STATEENERGYSUPCHARGE �;f <br /> AVPLiLR�IONnCC 0� �'LANSCHECNEDOY A��� FOFISSUANCEBY pUBLICWORKS � <br /> i TOTAL <br /> — PROPF.RTY OWNERS ARE R[SPONSiBLE FOR C'!'TERMINING ALL <br /> PROPERTV LINE LOCATIONS AND RCLATED EASEMENTS. <br /> i b. <br /> � . ..., ... . . . . r � �. ..�. .�r: .,�. .. .... , . . . . . . .�• _ _ <br /> t <br />