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� �PPLICATION FOIt- � ever�tl <br /> '".E".,°`"" CONSTRUCTION 0 <br /> �,r o. <br /> everett PERMIT � <br /> BUILDING DEPARTMENT <br /> 259•8870 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ CCiMBINATION ❑ BUILDING ❑ MECHAIdICAL ❑ PLUM8ING ❑ SIGN <br /> OWNEP M�IL�OORlSS ,JL CIIY ZIP PNONE <br /> vr:J/7G O/L d�'�iJaVN .�/.,S'N/r/i /C-�/ Su/,'c[' /"/t/r/f 9JJZG�' .SS S '�XSI <br /> •R�HIfEC10A0651ONER MMLAOOHE55 CITV 21f P ONL <br /> GlqERAL CON�H�G�O� M�R aflUfiC55 GtY J�P PUGHC LILPRf • <br /> NICN�Nif.q[ON�R�CIOR M�It�ODRESS CIIV 21P PIIONE LiCENSE• <br /> �J`Il � J"�riL <br /> FLOMBWOLONIR�GIOR M�II ��U�E55 l.��Y 21� PINNF liCENSE � <br /> CL�GS O�WOA• <br /> ❑ NEW ❑ A�DIiION ❑ ALTERATION ❑ AEPAIR ❑ DEMOLIiION OODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> wLU���ON Oi WOHK iCOSI O��•�a�C��>�+�'LU$Ufl�PI <br /> UESCR�tlC WOP• <br /> r1 <br /> USF O�BWlDiNO I HERLBY CERTIFY TIIAT I HAVE READ AND EXNMINED THIS AP- <br /> ` PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> ICO�LOESCHiPTIONO��AOPERtY�SNOVINBELOWORA1t�CMfOURCOP�f:51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHERSPECIFtED HERE• <br /> �oi_e�ock_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> .4NY OTHER STATE CR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. ` <br /> SIGN�iURE O�CONiRACiOA OR AUTHORIZED/GENi nn.e 3/�,S/J <br /> X / <br /> PPOJECi�DDAE55 �CPLICANTS CIIY BUSMESS LICENSE NO <br /> io7a.� 5�� /1 v� s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIVMENT FEE <br /> WATER ClOSET ITOILETI AIC—A/HNOIG UNITS—H.P. <br /> BATHTUB REFRIGEPATION UNITS—HP.EA. <br /> I,AVATOHY 1 WASH BASINI BOILERS—B.T.U./H P. <br /> SHOWER OAS FIRED A.C.UNITS—B.T.U. <br /> KITCHEN SINN Q DISP fORCED AIR SVSTEMS—B.i.U. M EA. <br /> OISHWASHER WALLHEATERS—B.T.U. M <br /> IAUNDRYTRAY UNITHEATERS—B.T.U. M <br /> CLOTHES W�SHER EVAPOPATIVE COOLERS <br /> URINAL CIOTHE50AYERS <br /> ORIN1(ING FOUNTAIN VENTILATION FAN <br /> FLOON DRAIN RANGE HOOD <br /> B�CKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS—�AINLEAOERS WOOD STOVE <br /> SINK ISERVICE—BAN.ETC 1 METAL FIFEPLACE d CHIMNEY <br /> FIREPLACEINSERT <br /> MEATPUMP _ <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUBTOTAL S SUBTOTAL <br /> PERMIT ! VFRMIT <br /> TOTALFEE f TOTALFEE I <br /> �RpNf SEt9eCK RE<n 5['d�CK Si�li SE1BnGH - PLAN I;HECK NUMBER FEE AECEIPT NO. I <br /> use mne ior ance yp�q�T S�i[ FEES VALUATION FEE '. <br /> or�s nrio 5 <br /> BUILDING <br /> IYVEO�CON51 OCf.11vnNCYGROUP NDDI°pWFL�INGUNIiS �� <br /> PLUMBING <br /> 54E O�BIOG NO O�SIORiES MU: pGG IOAU <br /> MECHANICAL <br /> OTHER I <br /> FIRE SPRINKLERS REOUIR[D ❑ YES ❑ NO STATE BUILOING SURCHAFlGE <br /> ' STATEENERGYSURCHARGE <br /> nnv�rt;c1iON nCC 0• �'� ='b GI�ECrcEO BV AnG�A f0�1 iSSUANLE BY <br /> PU9LIC WOflKS <br /> TOTAL <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING PLl <br /> PROPEFiTV LINE LOCATIONS AND RELATED EASEMENTS. <br />