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., . :. . .. <br /> fA�Eveifl�ean ^I'PLICATION FOI�I evereit <br /> CITVOF CONSTRUCTION � <br /> everett PE RM IT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> BUILDING DEPT. <br /> 259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEq MAILRO�RESS ITY 21P PIIOIlE ' <br /> `',I�P�Y���r� D�v C'��� r3b �J� 1S�n�h �IL (�nIIPULI.P, � `RCx> � �� B -�. <br /> pqCMRECTOP0E51GNEfl MAILADOFE55 Cltt ZIP P�IONE <br /> GENEfl�Lb�NiFACTOfl MAILADOBESS piY ZIP PIIOIIL IICElISE• <br /> MELMANIGALCONTPACTOq MRILADURE55 CITY ZIP PIIOIIE LICEtlSE• <br /> PLUTABING CONTPACTOR MAIL ADDflESS CIIV 21P PI�0�1[ lIC[HSE r <br /> ��i'`�i(l��h � '�I �vr1���ir�^r (,r-� ,t r �a r+�,�_Il ��i�� f:-��,�v,� �- '��$>1'`� ;3���v/7/ <br /> CLA^�S OF WOflK '� �{O,g,•���— <br /> �. NEV! ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ IiUILDING RELOCATION <br /> VA WATION OF WORK�COST OF MRTERIALS PLUS LABOR) <br /> OESCRI9E yIPRK <br /> �J �ti 1:,i�c�. <br /> USEOFBUILDING � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> Y-"IY �N. '-- PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> �ecuoeslllPTIOtlOFPflOPERTYI5110WN9ELOWORPTfACHPOUFWPIE51 pROVISIONSOFLAWSANDORDINANCESGOVEPNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITIi WtiETIiER SPECIFIED HERE• <br /> �or—e�oc�—oF IN OR NOT.7HE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANYOTFIER STATE OR LOCAL L%�W REGULATiNG CONSTRUCTION <br /> � OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATfIRE OF CONiBACTOR OR AUTHORIZE�AGENT OATE <br /> X � �( a(. / ���4') � .(. � <br /> PflOJEQA�OFE55 APPLICANTSCttYDU5WE551 ENSENO. <br /> ��2. � - � -1h s - � �o � ��- c,�� ��r�� �.� ( <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEflCLOSET�TOILEp � �• P AIRCOND. UNITS—H.P.EA. <br /> BATMTUB -� � C.�� REFRIGERATIOIJUNITS—H.P. EA. <br /> LAVATORV�WASH BASIN� • � �� '�iU- �OILERS—H.P.EA. <br /> SHOWER � �`�1LJ GAS FIRED AC. UNITS—TONNAGE EA. _ <br /> KITCHEN$INN Q DISP. r7 �7 FORCED AIH SYSTEMS—O.T.U_M EA.� <br /> DISHWASHEfl J�, WALL HEATERS—B.T.U. M <br /> LAUNORYTRAV UNITHEATER5=8T.U. M <br /> � CLOTHES WhSHER � )�� EVAPORATN[COOLERS <br /> 1 WATER HEATER � CLOTIIES ORYERS _ <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE NOOD <br /> FLOOR DflAIN AIR HANDI.ING UNIT— GF.M. <br /> VACl1UM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADEFS IAETAL FIREPLACE 8 CHIMNEY <br /> SINK SEflVICE—BAR,ETQ WOODSTOVE/FIREPLACE INSEflT <br /> SUBTOTAL � � SUBTOTAL S <br /> PERMIT 5 PEf1M1T 5 <br /> _ TOTAL FEE S ��J_,Cj__i TOTAL FEE S_ _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONTSEtO/CK fiEARSETBACK SI�LSEidACK PUNCHECHNl1A1BEB Pl<NCHECKFEE <br /> FEE RECEIPlNO <br /> USEZOIIE LOTRREA ypCANTSIiE <br /> FEES VALURTIOtI FEE <br /> OYES ONO -- — <br /> iYPEOFCONST. OCCIIPANGYGROIIP NO.OFOWELLINGUNITS <br /> BUILOING 5 <br /> S12EOFBLOG NO.OFSTORIES MAX.00C lOAD — <br /> PLUMBING <br /> MECHANICFL <br /> FIRE SPRINKLERS REOUIRED ❑ VES ❑NO <br /> OTHER <br /> PENALTV <br /> APPLICATIDNRCC BY PIANSCHELHEOBY APPR.fORI55UANCEBY <br /> TOTAL <br />