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��.Ew,o,,,� . .PPLICATION FO.- ���,�„ <br /> ��n�F CONSTRUCTION � <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL p PLUMBING ❑ SIGN <br /> OWNEP MAIIADORESJ GITY 21P PHDNE <br /> E�e/1GQee,J TN�iFtu��y _ <br /> ANCHIIECiOR0E51GNER M�IL���RESS CITY ZIP VIIONE <br /> f-�u ss nta un� 2e FR�6.� �n�c• ��i�/o W. n�aeqiNJ(Gl�SO. SC'A7ll(C 7��3•9osa <br /> GENENA��ONiR�L10R M�ILAO�NE55 CIIV ZIP PMONE LICENSE� <br /> C•�. A. �Ua57/lctc>/oaJ Kio[Ceuue (.:�3 '6�zo <br /> MEGHANIC�ICONiRAGIOq M4ILADDNE55 GIiY ZIP PH011E IILENSE� <br /> �e 1 S1C�� <br /> PIUMBINGCOMPAGtOR M�ILAOORE55 CIiY 21P PI�ONE '�]!{T�T(iL E 5� <br /> Ki,u� CouNra ��E��AN��a� ��qio �•�., sr. .sf qu�u,�,�, wA �Pj j-,S-�O�r <br /> CL�55OF WORN <br /> ❑ NEW �.ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> WLU�TION OF WORK�COST OF M4IEOIRLS PLUS LF90f11 <br /> DESG�i�E WOAN <br /> ReMe�e� ex�s��he A00 Ne� F�xt�2P1 s e26eCa�, <br /> use oreunoirva 1 HEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS AP� <br /> 1�.etA1L F��c�IS . PLICATIONANDKNOWTHESAME70BETRUEANDCORRECT.ALL <br /> IEG�L0E5CPIP110NOFPROPEflfV�5110WNBElOWOF�TTACIIFOU(ICOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �oi—e�oc�_ov_ IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTqUCTIOD! <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNAi OFCO RACTOR AUTHORIZEDAGENT DATE <br /> \ <br /> �.. _� — �v-86 <br /> PROJECTRODFE55 /P ILr1N SCIt LIC ENO. <br /> �JP �P rit�k � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TUflE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILETI AIR COND. UIJITS–H.P.EA. <br /> BATHTUB REFRIGERAiION UNITS–H.P.E�. <br /> LAVATORY(WASH BASIN) BOILERS–II.P.EA. <br /> SHOWER GAS FIREO 0.C.UNITS–TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCE�AIR SYSTEMS–B.T.U. M EA- <br /> DISHWASHER WALL HEATEPS–B.T.U. M <br /> LAUNDRYTRA� UNITHEA(ERS–B.T.U. M _ <br /> CLOTHES WASHER EVAPORA7IVE COOLERS <br /> WATER HEATER CLOTNES DFVERS _ <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR�RAIN AIR HANDLING UNIT– C.F.M. _ <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS–RAINLEAOERS METAL FIREPLACE 8 CHIMNEV <br /> SINH�SERVICE–BAR,ETC. WOODSTOVE/FIRFPLACE INSERT <br /> '� <br /> SU9TOTAL SUB70TAL S <br /> PERMIT S PENMIT S _ <br /> TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DFPT. PERSONNEL <br /> FRONiSEiBRGN (IERRSEtBFCN SIDF.SE7BFCK PUNG�IECNNUMBEfl PLANCi�ECefEE <br /> FEE RECEIPI NO <br /> USE ZONE lOf R(1E� yp�ANT SIIE VALURTION FEE <br /> FEES <br /> pYES l]NO _ <br /> TYPEOLCON51. OCCUPRNCYGROUP NO.OFDWELLIN6UNIfS <br /> BUILOING 5 <br /> SIZE OF BLD6. NO.OF SLORIE9 MF[OGC.LORO <br /> PLUMBING <br /> MECH�NICA�. <br /> FIRE SPRINKLERS FiCOUIRED O YES ❑ NO <br /> OTHER <br /> PENALTV <br /> RVPUL'l10NACG.BV PLANSCMECNEOBV RPPP.FOBISSURNGEBY — <br /> TOTIIL <br /> L - � - <br />