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,�.E,.,,,,,� . �PRLICATION FCI.. <br /> `�^�` CONP RM TTION `"e <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8745 TO bE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ pLUMBING ❑ SIGN <br /> OWNER M�IL�OOHE55 CITV LIP PNONE <br /> G����� �'k'"��� `�ql`'� • �"�S�E,b� �VdY /K -rT 9820 2s`I �2(,2 <br /> �NLMIIEGIONOESIGNE� M�ILAOORE55 GIIY iIP PNONE <br /> GENEMICONTP�CIOA MFILRODflE55 LIIY ZIP P11ON: LILFNSEa <br /> MEf.H,1NIGL GONIR��TOq M+11L qODflE55 CIIV Z19 PIIONC LILENSE• <br /> 11iu,SMd��u r2 i� �4Ao-�/ ,ioi�Ne� ��Y � 5�a-r,-�.� �t�i� �c�.�,o�o u, SMIZ�I�_lL <br /> PLUMBINGCONiRACTOR M�ILADOBE55 CITY ZIP PIIONE LICENSE• <br /> C1�55Oi WOPN <br /> ❑ NEW � ADDI710N ❑ ALTERATION ❑ REPA�R ❑ DEMOLI710N ❑ WOODSTOVE/FqPL.INSERT ❑ BUILDING RELOCA710N <br /> W W�LON OF WOBK�COSi OF MRt[qIpLS PWS UBOR� <br /> � � ,q� � <br /> OESGqiHE ORN <br /> l.L d T\V E G ���� <br /> use or ew�ovuc <br /> G� I HEREBY CERTIFY THA7 I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEWLDESCBIPIIONOFPqOPERtY�SHOWNBEIOWOFATTpCNFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> io�_eioc�c.__ov OF WORK WILL BE COMPLETEG WITH WHETHER SPECIFIED HERE- <br /> iN OR NOT.THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW FlEGULATING CUNSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUREOFCONiRFCTORORAUTHOPIZEDAGEN� DAIE <br /> X ' • 25 -8 <br /> PROJEGiADOf1E55 � ' <br /> APPIILANiS CITY pU51NE55 LICENSE NO <br /> �' d ETT VQ, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND. UIJITS—H.P.EA. <br /> BATHTUB REFRIGERA710N UNITS—H.P.EA. <br /> LAVATORV�WASH BASIN� BOILERS—H.P. EA. <br /> SHOWER GAS FIRED A C, UNITS—TONNAGE EA <br /> KITCHEN SINK6 DISP. FOPCE�qIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALLHEATERS—B.T.II. M <br /> LAUNDRV TRAV UNIT HEATEfiS—B.T.U. M <br /> _ CLOiHES WASHER EVAPCRATIVE COOLERS <br /> WATER HEAT[R CLOTH[5 DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKIN3 FOUNTAIN RANGE HOOC <br /> FLOOR DRAIN AIR HAN�LING UNI7— C.F.M. <br /> VACUUM BREAKEFS STOVE <br /> ROOF DFAINS—RAINLEADERS METAL F'IREPLACE 8 CHIMNEY <br /> SINKISERVICE—BAF,ETC. WOOOSTOVE/FIREPLACEINSERT <br /> SUB TOTAL SUB TOTAL 5 <br /> PERMIT S PEHMIT S <br /> _ TOTALFEE S 70TALFEE <br /> S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONi5E1BACN REARSEiBACN SIpE5ET6ACK P�ANCNECNNUMBER VIANCM[GNI[E <br /> FEE REC[IPi NO <br /> USE20NE LOfRpER <br /> VRCANTSIIE FEES VRLUATION FEE <br /> OYES pN0 <br /> tVVEOFCONSi. OCGUPANCYGROOP NO.OFpYIELLINOUNliS <br /> BUILOING S <br /> SREOFp�DG. NO.OFSiOPIES M�%.OGGIOn� <br /> PLUMBING <br /> MECMANICAL <br /> FIRE SPRINKLEFS REQUIRED ❑YES ❑ NO _ <br /> OIHER <br /> AOP�IC4110N RCC BY PUNS CHECHEO BY pPPp.FOR ISSl1ANCE BY PENALTY <br /> TOTAL <br />