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�h.Ewro,N� CONSTRU�CTION � <br /> GIfY OF <br /> ererrtl <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE pRIWT <br /> ❑ DElIAOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> OWNEN MAILAODRE55 Cltt ilP PIIONE <br /> _ EUP{� �/�-YP�LJ �fIQ/FTLv�d�/ �/9/9 E�r���Fo� ��S/ C�PKC� <br /> MCMfECTOR0ESI0NEB MRIL�DORE55 Clrv 21P PNONE <br /> FIu SS ruAn� Y. F ��IGPi1A1'!J•J <br /> GfNENAIGONIR�GiOR MAIL�DORE55 CITY ZIP PIiONE 4CENSE• <br /> C.. . UJ. ►a CUNST2uc?ron� 73eL(r�w < (,�A (c.,a3 G>�/zc� <br /> MECMANIGICONIfIRCiOq M�I�ADDPESS CITY ZIP 19�pNE �IC[NSE• <br /> J�IN � Cou,�7�1 ,ntFcl,AN�ca( �9/U 'Y " SrQ�er SE AuG�v�ti,�.,,_d ,�J3-S`zo,Q <br /> PWMBINGCONiR�G10R MMIApDflESS CItY 21P PIIONE �ICENSE� <br /> Gl�SSOF WORN <br /> ❑ NEW �ADDITION ❑ ALTF.RATION ❑ REPAIR ❑ DEIr10LITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LU�f10N FWOlIK�COSIOFMAlEfl1ALSPWSU�ON1 <br /> �f��J <br /> � <br /> OESCH BE WORN <br /> — A00 GAs F"il'�,�v 7a ��c�u1 3e,��2�/ qt�<'iTio•,/ _ <br /> use or ew�oiNc <br /> F�od 5�„�,L�) ( �� J�i I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP• <br /> PLICATION ANO KNOW THE SAME TO BETRUEANDCORRFCT.ALL <br /> LEG�lOESGqIPiIONUFPROPERiY�511iJWNBELOWOflAT �CMFOURCOPIESI pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �oi_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 /> ANYOTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION <br /> OR TliE PERFORMANC�pF CONSTRUCTION. <br /> SIGNATURE CONTpnC RpRAUTHORREDnGEN7 OnTE <br /> ' � G't ' A.1� � ,��Z �'6 <br /> FHOJELT�DDRESS APPL iSCIT U IN ENSEN <br /> v - ��,a-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUHE FEE NO. 7yPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) qIR CONO. UNITS-H.P.EA. <br /> BATHTUB REFRIGERATION UNITS-H.P.EA. <br /> LAVATORY�WASN BASIN� 801LER5-H.P.EA. <br /> SHOWEF GAS FIRED AQ UNITS-70NNAGE EA <br /> NITCHEN SINK 8�ISP. FORCED AIH SYSTEMS-B,T.U. M EA. <br /> OISHWASHER WALLHEFTERS-B.T.U. M <br /> LAUNDRYTHAY UNIiHEATERS-B.7.U. A1 <br /> CLOTHES WASHER EVAPORATIVECOOlEtiS <br /> WATER HEATER CLOTHES ORYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AI{7 HANDLING UIJIT- C.F.M. <br /> VACUUM BREAKERS S70VE <br /> f100F DRAINS-RAINLEADERS NIETAL FIREPLACE 8 CHIMNEV <br /> SINK�SEflVICE-BAP,ETC. WOODS70VE/FIFiEPLACE INSEqT <br /> � <br /> / !�� <br /> SUB TOTAL SUB TOTAL 5 <br /> PEHMIT S PEPMIT S � � <br /> _ TO7ALFEE 3 TOTALFEE 5 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iHONi5E19ACK qEpq5ET8ACK SIpFSETBRCK PL4NCMECKNUMBEN P�ANLHECNfEE <br /> FEE RECEIPI NO <br /> USEZONE LOiARE.1 <br /> VACANiSIiE FEES VqLO�T�ON fEE <br /> OYES 1]NO <br /> ttPEOFCONSL OCLUPANCYGROUP NO.OFOWEILINOIINIiS <br /> BUILDING 5 <br /> SILE OF BLDG. NO OF StORIES MAX OGG LOAO <br /> PLUMBING <br /> MECHANICA� /� Q� <br /> FIRE SPFINKLERS REOUIRED ❑VES ❑ NO <br /> OTHER <br /> PENALTY <br /> APPUCRtIONACC.BY PUNSCHEGNEDBY RPPR.FORISSURNCEBY � <br /> L G � TOT.� �� - <br /> _ �_ <br />