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1 , <br /> A .)PLICATION FOR Fr'R11•• <br /> TheOF <br /> CIT"OF. »° CONSTRUCTION 0 <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 260.8310 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION Li COMBINATION O BUILDING O MECHANICAL PLUMBING ❑ SIGN <br /> Ow"I'luAII AOOPI/ cRY IIP M0N[ <br /> may+ 2 CU5!CEJ1 ?k�t1ES (o130CC-1,.IRf• e ivy 987c:i 5`/ —CI$ S <br /> �ncNu/Cr On oL naMCR MAIL AOOR/O CITY top PHONE <br /> nt'If PAL CONIRACIOA MME ADDRESS CITY IIP PUONE LMENFE• <br /> STT42LUS?u Y1�JHI <br /> ES r< tuv - Le T,1 MErl•c l EvJ 94Zn3 3y ) <br /> -C., <br /> Mf OIAIWILL CONIRICTnn MML AODntS/ Clir IIP PHONE ICINR• <br /> PLUM/NIn CONIRACIOR MAIL ADDRESS CITY ZIP MADRE LICt"ll. <br /> TiRAina- P-nal 7' Pe. ao7//el ej9VZ_ ?T37 /lil Til'Ar.9-r�sy�/� <br /> r,�L7A( won" <br /> AS Or <br /> 1Q\NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEmPIPLANSEPH ❑ BUILDING RELOCATION <br /> – <br /> v40A11N11or WOn•,COSI OI IA A IL n1A16 MU/LANOM <br /> of SCNRt wo". <br /> �• i'l,.cJlat,',i,tJr� J N d7L1 P� EX <br /> wr ur nunomn I HEREBY CERTIFY THAT I HAVE. READ AND EXAMINED THIS AP- <br /> "X <br /> P- <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECt.ALL <br /> ��–'-----"-- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> llnAl Ot/CPI/11011 DI/RUI.1 nIY iSIIJ'NN nILUW OA AtTAC1110Un COMtII <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> tol_---.Rlocn_ol IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME 10 <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATUnEOr CONTnAcTOn On AU IOnItEDAGEN? ' DATE <br /> APPLICANTS City BUSINESS LICE NSE NO <br /> PROJECT ADDRESS _ <br /> –AO) / [1 �L S,/ <br /> PLUMBING 7 MECHANICAL _ <br /> NO. TYPE OF FIAIUnE On If EM FEE NO. TYPE OF EQUIPMENT __ FEE <br /> WA TEn CLOSET(TOILE 11 AIC—AIHNDLG UNITS—N P <br /> BATI.TUB nEFnIGEnATION UNITS '.EA. <br /> UVA CORY(WASH DASIn) BOILERS—B T.UMP. <br /> SIIOWEn OAS FIRED A C.UNITS–&T.U. <br /> _;_1TCHEN SR D:A DIST` __ fOnCEO AIR 9YSTEM9–B.TU. MEA – _ <br /> - WALL NEAIEn9–B.T.U. M <br /> y DISHWASHEn M <br /> -- <br /> UNIT NEATER9–D.T.U. <br /> LAUfIDnY TnAY <br /> EVAPORATIVE COOLEn6 <br /> CLOT TIES WASHER <br /> CLOTHES OnYEnB <br /> URINAL <br /> VENTILATION FAN <br /> OnINKING FOUNTAIII <br /> HOOD <br /> nANGE"EAI <br /> fL000 DnAIN � — <br /> BACKFLOWPREVENTEnR �., WATER HEATER _— <br /> ROOF On AINS–RAINLEAOEnS WOOD STOVE <br /> SINK(SERVICE–Onn EfCl METAL FIREPLACE 6 CI!IMNEY <br /> FIREPLACE INSEnT <br /> HEAT PUMP <br /> I PIPING <br /> EKIIAUST FAN <br /> SUS TOTAL i SUS TOTAL – <br /> rEnMIT E PERMIT I <br /> TOTALFEE E TOTALTEE <br /> �uUr1i SFIOAU nTAI19F(SAW SIDESEISAOK <br /> RAN CHECK NUMBEn FEE nECEIPT 110 <br /> USE tuna LOIARtA VACANT SIZE FEES VALUATION FEE <br /> UYES ONO S <br /> BUILDING _ <br /> TYPE Of CODST MCUPA14CY CROUP NO OF DWELLING UNITS <br /> PLUMBING _ <br /> 5O1 OI SIDO Wl"?N141.0111 MAR OCC LOAD MECHANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOVIRED U YES O NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE _ <br /> APPLICATION ACC EY /'IANSCHECIEDSY A Prn Ion ISSUANCE By PUBUCWORKS <br /> TOTAL <br /> PROPERTY OWNEnS AnE nESPONSIBLE TOR DEIEnMINING ALL <br /> PROPERTY LINE LOCATIONS AND nELAIED EASEMENT& <br />