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' �r,PPLICATION FO�, <br /> � '"°`"'°"'" CONSTRUCTION !`°`�" <br /> un oF <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING C MECHANICAL 'y�PLUMBING ❑SIGN <br /> OWNER M�ILA�ORE55 CItV 21P PMONE <br /> 1�ea�•ca/ OS�6C 3//y oa.�i !'vQ y,4�,�0/ � <br /> •N RE�C,OROlSIGNER M�R�DDRE55 CiiV piv PNONE <br /> �a/es�Cd/Y'��` /�do¢ /,6�7���R .k'��� 9P�3 � s^9 ;o�6d' <br /> GENEP�I LONIR�CIOR M�il A�OPE55 C�rv zio n��ONE LiCENSE• <br /> �e.�e� cA.,.r� i� �a�-y�D.. a.E: ����ys�� 9�.'ifl'0 6S�'-/G �� <br /> ME(M�NIC�L CONiNe�jaq h�Ail�uBn[SS Cllv LIP • PnONE �ICENSE• <br /> FLpM91NGCONiR�j M�II �DORE55 CIiY 21V` J/` SE • <br /> !/' �. 7'�D7� � T_/,. ao/ �l� <br /> .f �� �O arS' ' . CO. 3.� .S'F s'eva�o..�.. . <br /> /SSOL'WORN <br /> ❑ NEW ❑ ADDITION � ALTERATICN ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSER7 ❑ BUILDING RELOCAiION <br /> W LU�TION OF WORN�CO51 Of MAIERI�LS PlUS L�flORI <br /> i <br /> DESCN�BE WORN <br /> I USE OF BUIlOiNG <br /> I i1EP.EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> ! PLICATION AND KNOW THE SAMETO BE TRUE ANDCORRECT.ALL <br /> lE0�L0E5CRIPTIONOFPROVERTY�9MOWNBEIOWOR�TT�CNFOtIFCOP�ES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILI BE COMPLETED WITH WNETHERSPECIFIED HERE- <br /> �or_e�ocK_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANV O7HEF STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR Tn� !".^,FORMANCE OF CONSTRUCTION. , <br /> SI�NAIUAEO� N111RC10RORApiHON12E0RGENT pATE ! <br /> � /�-/S'=?� � <br /> PROJECT�DORE55 �PPIiUN CilYflU9 ESSLiCkN5EH0 ' <br /> � //� � d �S � '� <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. T'PE Of EGUIPMENT FEC <br /> WATER CLOSET�TOILET) MC—��MN�LO UNITS—H.P. <br /> BATMTUB qEFRIGERIITION UNITS—M P.EA. <br /> � LAVATORV�WASN BASIN� BOILERS—B.T.UINP. <br /> 1 <br /> SHOWER Q�S FIRED A.C.UNITS—B.T.U. <br /> � KITCMEN SINK�DISP FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DI9HWI13MER WALLMEATEHS—B.T.U. M <br /> � LAUNDRV tR�V UNIT HEIITERS—B.T.U. M <br /> + CIOTMES W�SHER EVAPORRTIVE COOIERS <br /> URINAL CLOTMES DRYEfiS <br /> ORINKINO FOUNTAIN VENTIUTION FAN <br /> F�OOR ORAIN RANGE HpOD � <br /> BACIfFLOW PNEVENTERS WATER HEATER <br /> i <br /> ROOF DRAINS—RI11NlEADERS WOOD STOVE � <br /> SINK�SEFlVICE—B�R.ETC� METAL FIREPIACE 6 CHIMNEY <br /> FIREPUCE INSERT <br /> MEATPUMP <br /> GAS PIPINf3 <br /> � EXHAUSTFAN <br /> SUSTOTAL f SUSTOTAL <br /> � PERMIT f P[RWT <br /> TOTAL F[E f TOTAL FEf <br /> � iRONi5E1B�CK RE�NSETB�CN Si0E5EiP�Crt �ANCHECNNUMBER FEE RECEIPTNO. <br /> USE20NE �OfARE• <br /> i �_s VAC�Ni511E FEES VALUATION FEE <br /> L1vE5 ONO <br /> BUILDING S <br /> TYPEOF�ONSi OCClIP1NGYGNOUP NOUFOWELLINGUNIfS <br /> PLUMBING <br /> SiZE Of glU6 NO OF Si0RIE5 M�It OCC lOAO <br /> ,�7�9 .� MECMANICAL <br /> OTHER <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO STATE BUILOING SURCHARGE <br /> STATEENERGYSURCHARGE <br /> I APPLICRIIONA(;� BV PI.ANSCNECNCOBY ePVRfORiSSu�NCEBY <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTV OWNEFS ARE RESPONSIBLE FOR DETERMININ6 ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />