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Ms Everpresn �►P P L I C AT I O N F O .: � � e��,e„ <br /> CiTYOF CONSTRUCTICIN � <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PR�NT <br /> BUILDING DEPT. <br /> 258-8745 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfl � 0C� MAILROORE55 CIiY ZIP , P11011[ <br /> SµERMu—,�rbt;-:��t� - ••�5o No�enwP waY �r�� 960�4 828-94a5 <br /> AflCNIiECTORUE5IGNEF MRILADDl1ES5 CIiY ZIP PIIONE <br /> �µ�e.t.r.: �aru+�Kd As1bc �3d B�vtrw( raNS' �G+�rt�r-r 992n3 353- 2388 <br /> GENEflALLONTRRCTOR MPILADOfiE55 GITY 21P PIIONE 4CENSE• <br /> .�r���l-�»^� �'�o .1.,uc . Sov I�e�"N e 5�,,.-t��a 3ellevu� wR ��aoo7- �4�1-3934 <br /> MECMAtlIC/LCONTPAGTOq MAILAOOFESS Cltt ZiP C�1�1't y�m5fl���I�F i5[i � <br /> V <br /> PWMBINGCONTRACTOfi MAILAD�RE55 CItY ZIP PMONE LICENSE• <br /> CIASS OF WOPK <br /> � NEW ❑ ADDITION ❑ ALTFRATION ❑ REP.�IR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> W LU4ilON OF WORK�W ST OF MATERIRLS P W S LPBCN <br /> �f' 3, eSe, o9a <br /> UESLRIB[WONK <br /> � Hew 1oa ur�rr APaarn+�-r <br /> useoFeuuomc <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PL�CATION AND KNOW THE SAMETO 8E TRUEAND CORRECT.ALL <br /> LEGA�DESCRIPiIONOFPflOPEflTY�5N01VN8ELOWORATTRCNFO1/1iCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WOflK WILL BE COMPLETED WITH WIiC-THEF SPECIFIEU hIERE• <br /> �or_o�oc�—or IN OR NOT.THE GRANTING OF A PEflMIT DOES NOT PRESUME TO <br /> C�IVE AUTHORITY TO VIOLATE OR CAIdCEL THE PAOVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> � ' SIGNATUREOFCONf(iACTOflORAUTHOfl12EDAGERT DATE IJJLBS <br /> X � <br /> PROJEGT RODRESS NPPUCPNTS CITY�1151NE55 LICENSE NO. <br /> -��� ��3ti 12r� 5T <br /> PLUMBING MECI{pNICAL <br /> NO. TYPE OF FIXTUpE �y-FEE NO. TYPE OF EDUIPMENT FEE <br /> �Z WATER CLOSET(TOILEA 'G� �_ A�R COND. UNITS-IIP EO.. <br /> �� BATHTUB � REFRIGERATION UNITS-H.P.E0. _ <br /> IZS LAVATORYIWASHBASIN) OO BGLERS-HP.CA. <br /> � SMOWER CAS FIRED A.C. U�11T5-TONNAGE EA. <br /> KITCHEN SINK 8 PISP. dO _ FOflCED AIR SYSTEMS-B.T.U. M EA. � <br /> �OB DISHWASHER �� (1�_ WALL HEATERS-B.T.U. M _ <br /> LAUNDPVTRAY UNITHEATBRS-O.T.LL Id <br /> O CLOTHESWASHER Q..00O EVAPORATIVECOOLERS <br /> I O WATER HEATER Z � ID CLOTHES DRYERS � V O <br /> URINAL IOE yENTILATION FAN 3TpL� U� <br /> DRINKING FOUNTAIN �9 RANGE HOOD __Q�G� <br /> FLOOR DRAIN (�_ AIR HANDLING 11N1T- QF.M. _ <br /> VACl1UM BREAKERS STOVE <br /> ROOF�RAINS-RAINLEADERS METAL F'IREPLACE 8 CHIMNEY <br /> SINK�SERVICE-BAR.ETC. WOODSTOVE/FIREPLACEINuERT _ <br /> SUB TOTAL � St1B TOTAL 5 �_ �a <br /> PEflM1T 5 PENMIT 5 <br /> TOTAL FEE S TOTAL FEE 5 8_ OO <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSOPJNEL <br /> FNONT SET�ACN REPR S[I�ACN SIOC SETOnCK PL�R CIIEGH NUMOLR PI PN Lil[CK IEE <br /> �`��p FEE 3a REGEIPtl10 <br /> USE20/D LOiApREA�/J� �O �S /�� �� �a�J �' O� / <br /> � � B/� 7L� SF �ACANTSITE FEES VALUATION FEE <br /> CTES pN0 <br /> ttPEOFCONST. OLCUPA�ICYGROUP N�-0F�WCLUNGUIUTS <br /> �- � �� � I I D � BUIL�ING S�j����LbO. �B.��O <br /> SIZEOFBLOGS NLO�.OFSiORIESc �^ MA%.00GpLOPD 2� <br /> ��Si !Ga i.� +:+. '�'}' KJ�� 1 2- IS PLUMDING � .SJn� <br /> MECMANICAL '8 J �JQ <br /> FIRE SPRINKLERS REOUIRED ❑YES NO <br /> OTf1Efl <br /> PENALTY <br /> RPPLIC4Ti0N ACC.OY PLnNS CNECHED BV RPPR.FOR ISSIIRNLE BY — <br /> TOTAL I ��8� <br /> ���� �� I�� . <br /> r� <br />