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8 <br />m <br />lir� [verpr�n <br />CIt'! OF <br />everett <br />BUILDING DEpAFTMENT <br />259-8810 <br />\PP�.�CATIOt� F�1 : <br />C�DNSTRI���'IC)N <br />PE�I�II�f <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOL�TION O COMBINATION l3'BUILDING ❑ MECHANICAL <br />___.__ r.inu noon[55 cirv nr <br />.9�<IJ� <br />� pm <br />everen <br />� <br />CJ PLUMBING G SIGN <br />mwr�e <br />�Z��'�i.�03 _ <br />���o��� <br />OENE�ALCONiRnC101i mnrt uovrrean �... ... . -.... <br />SE�GT 1-ION1 ES 5�[�-�N 1 I Z? �s <br />MECHANICAL CONIi1Pf.t0� MAIL ��ORE55 Cltv 21P {'110NE LIC[115E • <br />IDCA� NE�1TiN� <br />vwMnw��r.cr�innunn r.miinoones; c:nr z��� riw��e i��,snsE. <br />PHUCs PWn�Qi�1 T — -- — <br />CL<5501 VlORR <br />�NEW ❑ �D�IIION ❑ �LLTERh'ION ❑ RFPAIR ❑ OLIdUL1ilON ❑ WOODSTOVE/FRPLINSER7 ❑ bJILD�NG RELOCnTION <br />vniu�nur�urwuia�rnsiin�nnirn�a+u�ur.:/inr�qni �1R�n FLOOR r-�= 99S <br />��1-U/ d� G LG � �6" / ' .�f.Q�ILf'.L zNo �wo,2 �V =';`f4 <br />nrscnior.woak �G��-�� ,7 (nfl/LRCoE /�J ° `l8Q , <br />I.r..... {' ../ .. . G ,.. �. , �,n %S7/;il <br />pF pUll <br />LEGnL UEscnirnun u� rvn <br />LO��� DIOCM__ <br />aOD�ESS <br />sa�s �n� n�. �, <br />PLUMBING <br />NO. TYP[ OF FIXTL <br />WATER CLOSET�TOILET� <br />� BATHTUO <br />� LAVATORY�WASH BASINI <br />SMOWER <br />KITCHEN SINN h OISP. <br />OISHWASHER <br />LAUNDRYTRAV <br />� CI.OTMES WASHEF <br />ORINNING FOUNTAIN <br />FLOOF ORAIN <br />BACKFLOW PFlEV'cNTERS <br />ROOF �RAINS - RAINLEAOERS <br />SINK �SERVICE - BAH. ETC � <br />� <br />�HUHi5fI8AC <br />_ ti5o' <br />ucE ru��c <br />� � <br />ni" <br />ITEM <br />SUBTOTAL S <br />PERMIT f <br />TOTAL FEE S <br />M�� n[nn 5[IHnCK �f <br />�• v �fiS 5� ' <br />i or nnen <br />' <br />' OCCU��f1CYG00UP <br />L' <br />NO UI' SfOPIfS <br />i' n <br />sioe ssrunr,K <br />G� <br />VR� ❑I SRE <br />fvE.S nN0 <br />NO ^� DWfLLWf•111lIf5 <br />ocr, iono <br />APVII(J.IION ACf, pv I PIl.tJ5l:11ECNE0 UY I APPfI �OR <br />� <br />I HERGBY CFRiIFY THAT I FIAVE READ AND EXAMINED TIi15 AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAbVSAND ORDINANCES GOVERNING THIS TYPE <br />OF WOAK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR ��OT. THE GRANTING OF A PERMIT DOES NOl' PRESUME TG <br />Gll'E AUTHORITV TO VIOLA'fE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION <br />OR TNE PERFORMANCE OF CONSTRUCTION. . <br />SIGN4 � O GY /1�{fR�4C70R0 IIiHOR17.ED�GENT �A�E <br />� 7✓ i %��i(1/ �✓u� . <br />XN�`/ �d/.//ZYI._. _—.. ._ �-Z�-9� <br />MECHANICAL <br />NO. <br />TYPE OF EDUIPMENT ^ _ <br />A/C - A/HNUIG UNITS - H P <br />REFRIGERA fION UNITS - li P. EA. <br />BOILERS - B.7 UlM P <br />GAS FIf7ED AC. UNITS - 8 T.U. <br />FOPCEO nlR SYSTEMS - B.TL. <br />K'ALI. HEATE(15 - O.T.U. <br />UNC IiEATERS - O.T.U. <br />EVAPOi1l.TIVE '.:OOLERS <br />CLOTHESDRYE�S <br />VENTILATION FAN <br />RANGEHO00 <br />WATEF HEATER <br />WOOD Sif7VE <br />METAL FIREPLl�CE 6 CHIMNEY <br />FIREPLACE INSEI7T <br />MEAT PUMP <br />GAS PIVING <br />E%HAUSiFAN <br />PI.nN CHECK NUMBER <br />�il i�,� ��,1`-�� <br />OLIIIDING <br />PLUMBING <br />MECHANICAL <br />M E�. <br />M <br />M <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />FEE <br />Zi <br />.��C�'/� <br />� <br />VALUATION <br />gGil 'iQ2 <br />STATE BUILDING SURCIIAPG <br />STnTEENERGVSURCHARGE <br />PUBLIC WORHS <br />TOTAI <br />FEE <br />PROPF.RTV OWNERS ARE fiESPONSIBLE F��H DETERMINING ALL <br />PROPERTY LINE LOCATIONS ANU f7ELATFD EASEMENTS. <br />/ <br />Z <br />