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. ,.../p/_: <br />/9 <br />, .PPLICATION FO�. ���,�„ <br />'".E".`°`"° CONSTRUCTION <br />CItY OF e <br />everett PE RM IT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �I MECNANICAL ❑ PLUII/�BING ❑ SIGN <br />�R L� •�VGUr►S 5,� l-05�3� �4v� W�erct-� 98203 355-�-I I q I <br />AIiC111iLC1ORUltiIGNf.❑ RIAIIP(J011(SS CIIY :IV PIIDNI <br />fiENENALCONTRFCIOF facll aUUR[55 Ci��' PP vuONl i.iLk1lSE• <br />..r�...ui�.� �nume�rna . M1IAII. a110NE:i5 CIIY � t6' CIIONE IICEIlSf. • <br />(]IY tIP PIIONF l <br />]U55Of WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ fiEPAIR ❑ DEMOLI71bN ❑ WOO�SiOVE/FRPL.INSERT ❑ Bl11LDING RELOCATION <br />�.ii inuncwnfiKicn.iOFI.IPtERIAIsrLusl.AliOni <br />USE <br />l01_ BLOCK_� <br />PR/OJE�CTa0DFE55 <br />✓✓O I � <br />PLUMBtNG <br />�'l <br />WnTER CLOSET �TOILETI <br />BATNTUB <br />LAVATOFYIWASHBASINI <br />SHOWER <br />NITCHEN SINK A OISP <br />DISHWASHEH <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTEFS <br />HOOF DRAINS — RAINLEAOERS <br />SINK (SERVICE — BAR. ETC ) <br />1 pplli SEipAf,n <br />US[ LON[ <br />rvPE Oi CONSi <br />AI'YLICAIION PCf, pY <br />I HER[BY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />raa�rouncovms pROVISIONSOFLAWSANDORDINANCESGOVERNWGTHISTYPE <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 VIOLAT[ OR CANCEL THE PROVISIONS OF <br />ANY OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON <br />OR TI1E PERFOFiMANCE OF CONSTRUCTION. . <br />SIilNAilIPL0/CON14iaCiONOqAUI11pqIZEOAGENT Il/IE <br />SUBTOTAL f <br />PERMIT f <br />TOTALFEE S <br />q[ANSEIpFLN 51[ <br />OCCUPANLY <br />or <br />VACANT SIIE <br />❑YES IINU <br />NO OF OPIFLL�NG UtuiS <br />MA% OLC L <br />APPR FOfl ISSURNLE �Y <br />(_ G� <br />� <br />�L <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A/C — A/HNOIG UNITS -- HP <br />REFFIGERATION UNITS — li P EA. <br />BOILERS — B.T U �H P <br />GnSFlREDAC UNITS—A.TU. <br />FORCED AIR SVSTEMS — B T ll. M EA. <br />WALL MEATERS — B.T U. M <br />UNIT IIEATERS — B T.U, M <br />EVAPORATIVECOOLER$ <br />CLOTMESDRYERS <br />VENTILATION FAN <br />RANGEHO00 <br />WATER HEATER <br />wOOOSTOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPIACE INSERT <br />HFAT PUhiP <br />GAS PIPING <br />E%MAUSTFAN <br />SUBTOTAL <br />PER411T <br />TOTALFEE <br />i+LAN CHECN NUMBER � FEE <br />FEES VALUATION <br />�U�LDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCH�RGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL , <br />FEE <br />RECEIP7 NO. <br />L` <br />PROPERTYOWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PFOPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />