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E.PRLICATI�N F'01. �vereN <br /> '".E".,°`"" CONSTRUCTION 0 <br /> cin oc <br /> everett PERMlT <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK• PLEASic PR{NT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OW��iR MAi�n00RE95 C�tt ZIP PHONE <br /> %i�n �A�mnJ '�la/S=/OT��AJe .Sc� �t/ 1��.3 .�:�4��957 <br /> •FLNIIECIOROE9�ONER M�IL�DDRE55 Gin' t�o P110NE <br /> GENER�L CONiReC10A MeIL AOORESS GITv ZIP OI�pNE IICENSE• <br /> ��/1 v',�,F-�oin���,r�o S3/�/a"'°.9� S' �J 9fao�'- ,333�Y,�)�-.17A��iciv��vi <br /> MEGMAwUlLON1P<CfOB MeILA00RE5S G�iv 21P P��ONE LICCNSE• <br /> FLUMBiNGCONIRIGIOR MULa0DRE55 CiTv ZIV PI�ONE IICENSE • <br /> CU55 Of WOAN <br /> ❑ NEW � ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRFL.INSERT ❑ BUILDING RELOCATION <br /> V�L W bON O�WONN�LO51 Of MA1ERUt5 PLUS LABORI <br /> �O U7l� - <br /> DESCPiBE WORK <br /> -- � - �,�r�e„� D� .� iS?N o - ��E <br /> use o m�on+a I HEREBY CERTIFV THAT I HAVE READ AND EXAMINFD TNIS AP� <br /> ��.16L� ����7/C I� PLICATIONANDKNOWTFIESAMETOBETRUEANDCORHECT.ALL <br /> LEG�LOESCRiPt10110��AO�ERiY�SMOWNOELOWOR�ITAGNFOURCOPIE51 PROVISIONSOFLAWSANDOR�INANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIEO I�ERE• <br /> �o��eioc�--o� � INORNOT.THEGRANTINGOFAPEFMITDOESKOTPRESUMETO <br /> 3 GIVE AUTHORITY TO VIOLATE OR CANCEL THc PROVISIO�IS OF <br /> �/ ANYOTHERSTATEORLOCALLAWREGULAT�NGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTiOiV. . <br /> SIGNnTURE OF CONLRRCTOR OR AUTHORi2E0 aGENT D4TE <br /> X . �--.�- / <br /> PROJELi�DORE55 �PF�I 1T5 CItY UUSINESS uLEN3E NO <br /> 9�/s= /0 T'`�,�IJ �s�= �v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYFE OF EOUIPMEN7 FEE <br /> WpTERCLOSET�TOIIET) S A/C—A/HNOIGUNITS—H.P. <br /> / �ATHTUB REFRIGERATION UNITS—H P.EA. <br /> � LAyqTpRY�WA5HBA51N1 BOILERS—O.T.U./HP. <br /> SHOWEF S GASFIflEDA.GUNITS—B.T.U. <br /> KITCHEN SINK d OISP FORCE�AIR SYSTEMS—8 T.U. M EA. <br /> OISHWASHER WALI.HEATERS—B.T.U. M <br /> LAUN�RVTRAY UNITMEATERS—B.T.U. M <br /> CLOTHESN'ASMEF S O EVAPORATIVECOOLERS <br /> Ua�NAL � C'_OTHES�RYEF$ <br /> OR�NKING FOUNTAIN VENTILATION FAN <br /> FLOOR OAAIN AANGE HOOD <br /> BACNFIOW PREVENTERS WATER HEATER <br /> FOOF OAAINS—RnIN�EnOERS WOOD STOVE <br /> SINK�SER410E—BA0.ETC� MEfAL FIREPLACE 6 CHIMNEY <br /> FIREPLACEINSERT <br /> HEAT PU.dP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUBTOTAL f SUBTOTAL �J <br /> PERMIT f PENMIT <br /> iOTAI FEE 3 TOTAL FEE <br /> �uUNiSEfps[e RE�RSEtBAGN SiDESEi9nCK FIANCHE('jKNUMBER PEE RECEIPTNO. <br /> an �� � �3� I �>�7'� I �x� �z� c���.� -. <br /> useto��E iornnen yp�qNi ne FEES VAWATION FEE <br /> _ , �' s3s �.ES ,�o s 2oZ <br /> BUILDING <br /> f1'FEOf�Si OCCUPANGYG�OUP NOOGOWFI.UNGUNITS <br /> � —N R- '� � PWMBING �S� <br /> srze ar o�ou r+o or£iOPIES MA%OG: lOFO <br /> 4�����D / J � � McCHANICAL <br /> OiHER <br /> FIRE$PRINKLEAS REOUIFED ❑ YES �NO STA7E BUILDING SUFCHARGE (� <br /> STATE ENERGY SURCHafiGE ` <br /> PVF�ICRIIONnCf, B� PIONSCNECNEDBY APPRFORISSl1ANLEBV <br /> PUBLIC WOFKS <br /> �JJ_� //!e _ � • G• TOTAL �l.S <br /> 4�1 �i /��r� <br /> PROPERiY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTV LINE LOCATIONS AND RELATED EASEMENTS. <br />