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■1 <br />„PPLICATION FOk EYEFE„ <br />CIT ve 1� <br />or "p <br />CITY CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING (7) MECHANICAL ❑ PLUMBING ❑ SIGN <br />��ru6 MAIL ADORES_- t ' call III- PnbNl '1 <br />hHh. t 5, 7T//ZxlEie, l/!e/A, f)WO qOF eOCs7” /, <br />( <br />B <br />m <br />MAIL <br />PI 1'A1p INIi Ct1r119ACIOR MMI WYNL aJ6036_ A/' nn Mr rnurn I IK INSt <br />7 <br />�7i�N� /IIl�7CK p,(Jrlfelmo� r:4WI/ < &W �/ S/ sY1 S A(nnFP ..�L3 $_ <br />C1 A55 UI WOPr <br />NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION - <br />Pat , A I NOF WOR. 1JSf )I LIA It BULL 5 PtI ABORT AV <br />--jL� �/W- <br />DIaCRIBIWONy 7 <br />/�AITAT.(�✓>/;JIJ OF wooU FmIneen AT/zcr/", //od r� Adl: r5/.c F.�C slow <br />Ilel JI B1ID UOru �- �p /� � <br />t. LT E <br />//%//)/� 7 (,<r ?I/,a CQI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING 1111STYPE <br />OF WORK WILL BE COMPLETEDWIT11 WHETHER SPECIFIED HERE• <br />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 />SIONAit111L O1 CONIRACIOR UN AUT"OR41.0 aUAN1 DATE <br />L.�/ /� yOrf 19tf1 <br />X� ' T , <br />11,;.I [If ti,' ')ION Or PROPLAT1.511OWN BELOW 09 AT FACII FOUR COPIE SI <br />'/i/� ZV SI '%il !"+-<% O/=. Ti%c Agri /-rZ <br />I,'I-BI ucl._OI <br />4c r4,4r /3.4r&d orkor Q R"c!T.DAI/.Y 77Yt%✓JW <br />}. <br />p ,y/ � <br />•%7�C•a.: fi/ IA)A A/C!d'A FAIT //r. aT .1 <br />0 1 /^ CC <br />b V O �'YJ <br />i 1 / <br />riT ' <br />I A <br />rW,rI, M111 SS'_ ®W pC� <br />•d� `hI�C� {•/ <br />AMN ICAN rN 6R r Uuslm 55 unrd rin <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TIME OF EQUIPMENT <br />FEE <br />WATER CLOSET ITON ET) <br />AIC - AIHNOLO UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - HP EA <br />LAVATORY (WASH BASIN) <br />BOILERS - B T U IH P <br />SHOWER <br />GAS FIRED AC UNITS - BTU <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS - B T U M EA <br />DISHWASHER <br />WALL HEATERS - B T U M <br />rI <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />rl <br />URINAL <br />CLOTHESDRYERS <br />DRINKING FOUNTAIN <br />VENTILATIONFAN <br />^ <br />I <br />FLOOR nRAIN <br />FLANGEHOOD <br />" <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />^OOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />1 <br />SINK ISERVICE -BAR. ETC 1 <br />METAL FIREPLACE It CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAB PIPING <br />EXHAUST FAN <br />%o <br />EUB TOTAL E <br />$US TOTAL <br />d2i <br />PERMIT E <br />PERMIT <br />TOTAL FEE E <br />TOTAL FEE <br />•, Nlat IBA,. <br />PLAN CHE KNUMBER <br />FEE <br />RECEIPT NO <br />nI AN SLI BACK <br />SIDE 9E)BACK <br />.111 :,INI <br />I'll". 049i <br />'^` <br />IOF AREA <br />OCCUPANCY GROUP <br />VACANT SHE <br />vLS IINU <br />NO OF DWr LEINO UNITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S �j <br />Ate <br />9E <br />PLUMBING <br />rIO <br />S !r .11 B• DO NO OF STORIES MAX OCC LOAD <br />1 <br />FIRE SPRINKLERS REQUIRED ❑ YES 4'NO <br />MECHANICAL <br />OTHER ta,�L, <br />t <br />STATE BUILDING SURCHARGE <br />.� <br />C- <br />STATE ENERGY SURCHARGE <br />Ar+I•.11IONAC.: 01 <br />P, INS CHECKED BY <br />AP PR FOR ISSUANCE BY <br />PUBLIC WORKS <br />PROPERTY UWNEHS Ant HFOYUHDIDEC run <br />-1--1� L.'r. ., a,- A (!,1 ' / :✓ f /ar" -ro Y (; PROPERTY LINE LOCATIONS AND PC ATE0 EASEMENTS. <br />Ir '. 11� 1411 .hl I , ..1.'r 11 .I i F' I I 1 f d-n +. I it's, 1 <br />