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fD� EvnprNn <br />cirv oF <br />everett <br />BUiLGING DEPARTMENT <br />259-8810 <br />❑ DEMO�ITION <br />OW��ER <br />%�e G uin <br />}I✓ <br />�'PLIC�IT►ON �0[�=� <br />COf��STR�JCTION <br />PERMfT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ COMBINATION <br />MRIL AODfi[: <br />ff sm. �� �o <br />MAiI nDDRE: <br />� BUILDING ❑ MECHANICAL <br />cin zir <br />.S'9� �fi' Sl ��� 9 <br />n <br />everetl <br />e <br />❑ PLUMBING ❑ SIGN I <br />�HONE <br />' Gs3 �o�s— <br />PIIONE <br />{ GENGflAI GONTR4CLOR MML aDDlI[55 CrtY ❑P P��ONE �ICENSE • ' <br />SQ i!'!e /�EL om /�a P% 'i <br />MELMAM1iC.LCONiPnCiOfl MAiLADDRl55 GIV ZI� PHONE LIC[NSE• I <br />, PWM�INGCONTRAGiOR MML/DDRE55 CiTV Zln PRONE LiCErvSE� j <br />' GU55 F WOAK <br />� [�EW ❑ ADDITION ❑ ALTGRATION ❑ REPAIR C� DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING REIOCATION i <br />' V�Ll1�T10NOFW,� ��JSiOFMRiEliiql5PW5LABONI II <br />/�J(,SoO <br />b i /. 9/G <br />IEGPL DESCRIPTIO OF PR <br />' lpl �BLOL�— <br />� /09/_3 <br />FqOJECTPDDRESS <br />PLUMOING <br />A�li / �� <br />iWNpELOW FN1tACNFOVR <br />/�qn SCi7 , <br />= /% S L' <br />TYPE OF FIXTURE OR ITEM <br />WATER CIOSET (TOILET� <br />EIATMTUB <br />LpVATOflV�WASH BASIN� <br />kITCHEN SINK 8 pISP. <br />pISHWASHEfl <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />IIRINA� <br />ORINKING FOUNTAIN <br />FLOOR ORAIf! <br />6ACHFLOW PPEVENTERS <br />ROOF ORAINS — RAINLEADE <br />SINK (SERVICE — OAR, ETC.) <br />SUBTOTAL <br />PERN�T <br />TOT�L FEE <br />� � FRONTSEIpACH RENF SETC>GH <br />Zn� �-�, <br />US`_ZOVE LOTARLA <br />"� 7��// <br />� ttPEOFCOpSi. OCCUPAI/GYGiIOII <br />� N �-3 <br />SIZE OF Bt�u. NG OF STORiES <br />//(v � � �- > <br />h��$ 1s.4-R . <br />�n'1 Irl � <br />rYl <br />aGB <br />� <br />5 <br />5 <br />SIO[ SETpACH <br />�� <br />VACAHT SITE <br />OYES LlNO <br />N0. OF DWEIIING UNITS <br />� <br />!Ap% OCL lOAU <br />N� CJ-/ _ <br />PPPR iOBILSUANCE OY <br />I kiERGBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS AP- <br />PLICAI'ION AND KNOW"fH E SAME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <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 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SI3NATUFEO�GON1RaCTGRORAUiHORIZEDAGENi pAiE <br />X ��, �if �%�=���� .a�A"as�8, <br />MECHANICAL <br />TYPE OF EOUIPMENT <br />A/C — A/HNOLG UNITS — H P. <br />REFRIGERATION UNITS -� HP. EA. <br />BOILERS — B.T U MP. <br />GAS FI(7ED nA. UNITS — B.T.U. <br />FORCED AIR $VSTEMS — O.T.U. M EA. <br />WALLMEnTERS—�.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVECOOLERS <br />CL9THE5 ORYEf7S <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVC- <br />IdETAL FIREPUICE d CHIMNEY <br />FIREPLACEINSERT <br />HEAi PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />VLAN(;MECK NUMBER <br />I <br />SUUTOTAL • <br />PERMIT ` <br />TOTALFEE S <br />FEE / z I AECEIPT NO. <br />� �a a 3s `� <br />FEES VALUATION <br />eullolNG g(����,' <br />PLUM6ING <br />MECHANICAL <br />nrHEa <br />STATE OUILDING SURCHARG <br />STAT�ENERGYSURCHARGE <br />PUBLIC WOFKS <br />TOTAL <br />FEE <br />FROPERTY OWNERS ARE R[SPONSIBLE FOR �ETERMINING ALL <br />f�liOPERTY LINE LOCATIONS AND RELA'i ED EASEM[NTS. <br />