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I�e Everpresn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />f-.�'PLICATIOfeI FOFa <br />CO�I�TRUCi�OIV <br />PftRMIT <br />TO BE COMF;_ETED IN INK- PLEASE PRINT <br />everetl <br />� <br />�{DEMOLITION ❑ COM9INATION ❑ BUILDING ❑ iNECHANICAL ❑ PLUMBING ❑ SIGN <br />OVIN[R / MAIIPQ E55 r� CIiY / ZIP I PMONE <br />l�" Gt r r O �l�X �% 3 /9%°���. �7� G�,°�7:J %�/,Z �i 7� C� <br />nRG�uT[CtOR�F.SiGNER � � A I L A O O i V E SS C I T Y Z lv PN Ok[ <br />GENERFL GONtaAQOR IdAil. nU0RES5 CiTv ZiP PUONE LiCENSE • <br />IALGIANIG4LCOMRPCIOB MNI�AOORESS CILV ZIP PHONE LICF.NSE• <br />VlOM01NGCON1R4CiOR IAAIIAD��E55 CIiY 21P PMONE UCE1lSE � <br />:�P55 OF \YORN <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RE�_OCATION <br />�F <br />DU'.LOirvG <br />LEGAL UESCfi�Pi�f d OF vH <br />ioi—e�oc�— <br />T��� 3� <br />PROJECTAODFE55 <br />^�'er �• <br />.�. 7o?u' <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />W �TER CLOSET �TOILET) <br />BnTHTU� <br />LAVATORY�WASM BASINI <br />SHOIVER <br />NITCHEN SINK d DISP. <br />DISHWASHER <br />LAUNDRYTFAY <br />CLOTHESWASHER <br />URINAL <br />DflINNING FOUNTAIN <br />FLOOR ORAIN <br />BACKFIOW PREVENTEF75 <br />ROOF DFAINS — RAINI_EADERS <br />SINK �SERVICE — OAF. ETC � <br />�NONTSEIDACN <br />USE ZONE <br />rvPC Of CONST <br />a�'NIICAIIONFCC �Y <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />fiEPR SEiBACH <br />OLCUPANCYGPOUP <br />NO OF STORiES <br />7ED ❑ YES O <br />PLANS CNECKEO BY <br />FOUR COFIE51 <br />a, <br />I HERGBY CERTIFY THAT I HAVE READ AND EXAMINED Tfi15 AP� <br />PLICATION AND KNOW TH E SAM E TO BE TRU E�9ND CORRL"CT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESGOVERNI�IGTliISTVPE <br />OF WORK WILL BE COMPLETED WITH 1NHETHER:�PECIFIED HERE- <br />IN OF NOT. THE GRANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OF CANCEL THE FROVISIOMS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCI'ION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATUPE O NTRA TGR OR AUTHORqED AGENT OFfE <br />X /� � -3 5 �Y�- <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/C — A/HNOLG UNI1S — HP. <br />PEFHIGEPATION UNITS — HP. EA. <br />BOILERS — B.T.U./H.P. <br />GA$ FINED A�C. UNITS — B.T.U. <br />FOPCED AIF SVSTEMS — flT.U. M EA. <br />WALIHEATEFS—A.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES�RYEFS <br />VENTIIATION FAN <br />RANGEHOO� <br />WATEFI HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIlANEV <br />FIREPLACE INSERT <br />HEAT Pl1MP <br />GAS PIPING <br />EXNAUSTFAN <br />SIOE SETHACN <br />VACANT SiTE <br />❑VES ONO <br />FO OF DWELLING UNIiS <br />�nnx. occ �ono <br />pPPR FOR ISSIIANCE OY <br />SUBTOTAL <br />PERMIT <br />TOTALfEE <br />?LAN(:HECK NUMBER �FEE <br />� FEES VALUATION <br />BUIL�ING 5 <br />PLUM0ING <br />MECHANICAL <br />OTHER <br />STA7E BUILDING SURCHARGE <br />STATEENERG�SURCHARGE <br />PUBI.IC WORKS <br />TOTAL <br />FEE <br />RECEIPT NO. <br />Fr_e <br />PROPERN OWNERS ARE RESPONSIBLE FOIi DETERMINING ALL <br />PFOPERTV LINE LOCATIONS AND REL�TED EASEMENTS. <br />