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��V <br />i-:'�PLICATION FOh.�% <br />+ ���`°,"" CONSTRUCTION <br />; everett PERMIT <br />� BUILDING DEPARTMENT <br />� <br />259-8810 TO BE COMPLETED IN !NK- PLEASE PRINT <br />� ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ lIAECHANICAL <br />f, �WHER f MAllA00RE55 LITV ZIP <br />' iL j����l,�L� ;�1� �G t" �i �'^..�-�i� ��i� <br />1 APCHR[CiORUESiGrvER MAiLAp0�E55 CiTV Zi <br />. � / <br />V <br />� GENERRL CONiRsIOR MnIL rODRES$ Cli! LIP <br />O PLUMBING <br />rnvn[ <br />v� �� <br />evereft <br />e <br />❑ SIGN II <br />� <br />, I <br />GENSE+ � <br />MEGHANILALCONIRACiOq IAAILAO[]N[55 CIIY Z�P PHpNE LIGENSE• '�. <br />! i `. i <br />V <br />PLUMBIN6CONiqAG10R AIAILAppRlSu ❑iV ZiP PIIONE LICENSE• ' <br />I I <br />i <br />� NEW ❑ ADDITION ❑ ALTEfiATION ❑ FEP�IR <br />VALUAT�ONOFWORNICOSIOiMAIE(VIhL5PLU5LPBOR� ', <br />�.e,.v. U %� A/t 17— cr �n �jZ_. <br />LEGRL <br />ioi_ <br />��� <br />N�, <br />P90JEGTAODRE55 <br />2rr �/'� I / ��'l <br />f � /iN�7Al.L c7F ,7 '` <br />PLUMBING <br />NO. TYPE OF FIXTURE OH <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORYIWASH BASIN� <br />SHOWER <br />KITCHEN SINN 8 OISP. <br />OISIiWASHER <br />LAUNDRVTRAY <br />CIOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRFVENT[RS <br />RUOF OPAINS — flAINLEA�EFiS <br />SINK �SERVICE — BAR. ETC.) <br />�AONi SEIfiACM. <br />�' <br />USE Z� <br />z <br />. TYPE OF CpryS� <br />✓ �� <br />. 512E O/F BipG <br />/�L U <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />PEhR SEIBACN SIOE SEiOnCH <br />2� ' _s ' <br />�ot nnEn yncnr r ire <br />yo 9s 5�. o�E,�o <br />OCCUP4NCYGROUP ��OOPOWFLI <br />�� � � <br />DEMOLITION ❑ WOODSiOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />ov <br />.___ <br />I HER[BY CE9TIFY TFIAT I HAVE READ AND EXAPAINED THIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF �h'ORK WILL BE COMPLETED WITH WHETHER SPECI�IED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY i0 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANV OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PEflFORMANCF OF �C�ONSTRUCTION. . <br />SIGN�iUPEA1f CONpRACTQN,9tLHVN�O{iIZED FGENi . O�i[ <br />X <br />6 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT FEE <br />A/C — AiHNDLG UNITS — MP. <br />FEFRIGERATION UNITS —H P. EA. <br />BOILERS—D.TU./H.P. ' � <br />GAS FIREO A.C. UNITS — 9.T.U. <br />PORCE� AIR SYSTEMS — B T.U. M EA. <br />WALLMEnTERS—B.T.U. M <br />UNITHEP.TERS—D.T.0 M J <br />EVAPOFAT�VE COOLERS <br />CLOTNESORYERS <br />VENTILATION FAN <br />RANGEH000 <br />WATER MEATER <br />WOO�S70VE <br />METAL fIREPIACE fl CHIMNEV <br />PIREPIACE INSEiiT <br />HEAT PJb1P <br />GAS PIPING <br />ExHAUSTFAN <br />/ I MA% OCC IOA^� <br />�� �'i <br />�. ov cinr�,cr�ecneooY <br />� /� <br />�/ <br />u��rts <br />Fon issunruce o�� <br />�/� <br />SUBTOTAL <br />PEAMIT <br />TOTALFEE 1� <br />V�nN CHECK N MBLR FEE� -� S RECEIPT NO. <br />�"8� 1 3 `L q5�_` <br />FEES VALUATION FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />O7HER <br />STATE BUILDING SURCHAPGE <br />STATEENERGYSUFCHARGE <br />PUBLIC WOFKS <br />TOTAL <br />PFOPEf?TY OWNERS ARE FESPONSIBLE FOR DETERMINING b.LL <br />PROP[RTV LINE LOCATIUtJSAND 9ELA7ED EASEME!JTS. <br />