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f,PPLICATION FOL PY <br />CIT Of »RCITY CONSTRUCTION 0 <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK - PLEASE PRINT <br />259-BB 10 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />MAIL ADPBf 59 LIIY SIP PIIOTR <br />OWNER <br />CITY ZIP w,ORE ULENSE . <br />MAN unm[ss _ <br />aLNEnq coNrn+clon ,/ / �K,{.� ✓.J •� ��jl SI.,µ EI.9E <br />i.,'Le /ln: ,� :� .-i1`/ On ftC 7U�� �6z'k P/1 l/✓� 6 [ sE <br />PLuuDlNn comn+unn Mm AnnR ss <br />]L ASS Of WORM <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />.11.1 nr I.IRMLs run IARORI <br />DESCRIBE WUnw,, <br />Or <br />CENSf A <br />REPAIR ❑ DEMOLITION ❑ WOODSY OVE/F RPLINSERT Cl BUILDING RELOCATION <br />LEGAL DESCRIPTION OF PROPER"ISNOWR OELOW On AITALr1 roan COPI[51 <br />LOI-DwCK--OA <br />PROJECT ADU,Rn <br />180 <br />PLUMBING <br />NO. <br />WATER CLOSET NOILETI <br />BATHTUO <br />LAVATORY (WASH BASINI <br />SHOWER <br />KITCHEN SINK A DISP <br />LAUNOnYTnAY <br />CLOTI/ES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />DRAINS — <br />ISEnVICE — <br />rn64l9rin+Ck <br />ETC I <br />IT5 TOTAL E <br />TOTALFEE <br />.n S[IMWOK <br />FEE <br />InACK <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICAHON AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />INOR NOT. THE GRANTING OF APERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOIHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Or CONTnACTUn On AUTHOIUZED AGENT DATE <br />X <br />MECHANICAL <br />FEE <br />A/C — A/IWOLO UNITS — H P <br />nEFNGERAIIUN UNITS —IIP EA <br />BOILERS — B T U /II P <br />GASFREDAC UNITS — BTU <br />FORCED AIR SYSTEMS — B T U M EA <br />WALL IIEATEnS — BTU M <br />UNIT IIEATERS — B T U M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER IIEATEn <br />WOOD STOVE <br />METAL FIREPLACE g CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXIIAUST FAN <br />gUR TOTAI. <br />PCRMIT <br />'— TOTAL FEE <br />I <br />M AN CHECK NUMBF R I <br />FEE RECEIPT NO <br />IOT AREA VACANT SITE FEES _ <br />OYES ❑rIO BUILDING S <br />I OI;COPANCY GnOLIP NO of-OWRl. LINO I1111TS <br />PLUMBING <br />NO Or STORKS MA. OCC I OAD MECIIANICAL <br />FIRE SPRINKLERS REOUInED ❑ YES O NO <br />APPnrJlNmIALC B� <br />OTHER <br />STATE BUILDING SUnCHAnG <br />STATE ENERGY SURCHAnGE <br />Arrn rOn ISSUMILE BY <br />PUBLIC WORKS <br />TOTAL <br />AM <br />PRIOPERTYOWNERS <br />I <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />ALL <br />A <br />