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APPLICATION FOR <br />CITECONSTRUCTION <br />theCITor Df <br />everett PERMIT <br />BUILDING DEPARTMENT 259•8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ? BUILDING ❑ MECHANICAL <br />l"�itl 5leiJ ���TfYEtfR <br />L l/i5 3 r 0 <br />❑ PLUMBING ❑ SIGN <br />MMt A00RE4S. CITY HP rnvnl <br />Y <br />PLUMBING CONIRAC TOn MAR AnOnE 9S CITY i1V PnONt IlClrrtif <br />CLASS Or WORT <br />[ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL. INSERT BUILDING RELOCATIOft— <br />vuwnoN or wnn. mosT Or r•.n. mAt s rt uS L•BOR <br />i C't <br />of SCRIBE WORT <br />L" (./sllA{ Y <br />Y` <br />usr or nu'yDorn <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />�)dUlZk <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORPECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE <br />or neorar. nnuwN nu OR •rTACNIWnLOPI[A <br />up•I otuB�nnorr <br />OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIEDHERE- <br />��1 t\ _�,C- <br />or <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 <br />to,—! L.BLock�'LC <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/CZti— Crr'— 1 L� %%�Y.�i�Y <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE Or CONIRAc TOR OR AUTHORIZED Alt' NI DATE <br />BUSINESS LICENSE NO G <br />PRO IE rt AODPES4 <br />APPLICANTSCITY <br />r n <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT FEE <br />NO. TYPE Of FIXTURE OR ITEM <br />A/C — AIMNOLO UNITS — H P <br />WATER CLOSET ITOILE tl <br />REFRIGERATION UNITS — H P EA. <br />BATHTUB <br />BOILERS B T UNP <br />LAVATORY 1 WASH BASIN) <br />6A9 FIRED A C. UNITS — B T U <br />D <br />SHOWER <br />FORCED AIR SYSTEMS — BTU M EA <br />KI tCHEN SINK A DISP <br />WALL HEATERS — B T U. M <br />DISHWASHER <br />UNIT HEATERS — D T U M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAY <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />iLOOR DRAIN <br />WATER HEATER <br />BACKFLOW PREVEEETERS <br />ROOF DRAINS—RA)NLEADERS <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />SINK )SERVICE — BAR E TO 1 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SUBTOTAL <br />SUB TOTAL <br />{ <br />PERMIT <br />PERMIT <br />{ <br />TOTALFEE <br />TOTALFEE <br />-- <br />f <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />r nONT 4F 10u'K rlf+n Ff )BACK Sint SETBACK <br />K <br />0 <br />L15PLll I <br />r <br />UM nrNt I1;1.1.1A VAr,ANT SITE <br />FEES <br />VALUATION <br />FEE <br />Imo•' I <br />LQO <br />BUILDING <br />PLUMBING <br />s <br />rvof nnv <br />�n • ur•Nc..nnpP <br />No or DWI Iun units <br />SQr Of "Intl <br />1Y1 •1r UniytS <br />MAa Oct.. LnA <br />�Y <br />MECHANICAL <br />1 y <br />Ioi <br />OTHER <br />HRE SPRINKLERS REOUIRLD OYES YNO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />11'1'I r;R110N AL C. B. <br />r�INS C.11ECKEEDD AV <br />APr'R ton ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />1^1 �^ <br />�IYII 711 \ <br />Ne Anv ncapnNSIRLE rOR DEIERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATFD EASE Men 1 B <br />