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. .PPLICAI'ION FO�. <br /> '"'`"""'" CONSTRUCTION `"°"" <br /> an oF <br /> everett PE RM IT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pLLM81NG ❑ SIGN <br /> OWNEfl M�IL�ODNESS Cltt IIP PIIONE <br /> �o/%?R /��Un/��ntc.r �- /9� aN�o - 7G�E Ma,��v� /�l J f�,ki- �3G aN�q <br /> •RLHIIECfOR�E51GNEfl M�IL�U�PE55 CITY ZIP PMONE <br /> �i_E-�crv�r��� lrC d, . (9ci�,.-�.nc�„� r7/nsf �� /�a���,avt iJF�! �j� (��.o �/�aq� <br /> GENERAI LONIP�CION M�IL AODPESS CIiY ZIP r PMONE � �ICENSE• <br /> M CN�NIGL CONTP�LTOq MAIL AODHE55 CI1Y 21P PMONE LICENS[� <br /> PLUMBINGCONIReGfOfl MAILApORE55 CITY ZIP PIIONE LICENSC• <br /> CUS50i WONN <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DFMOLITION ❑ WOODSTOVEIFRPL.INSERT ❑ BUILDING RELOCATIQN <br /> Y�IU�TIONOFWOFN�W5I0F1JAIE(IIAlSPIU$LABORI / <br /> 1 / � � <br /> :J��„�� O / 71( /n�C'C� ;�lo�-co�pt C 0 l�i,lo S <br /> nescai� o� <br /> lu / /<< ,u, • is �� f I v� (c�r�sG <br /> USE OF BWLOING <br /> ~� � �- I HEREBY CERTIFY THAT I HAVE IiEAD AND E%AMINED THIS AP• <br /> � �'��/ a ' � PLICATIONANDKNOWTHESAMEI'OBETRUEANDCORRECT.ALL <br /> LEG�LOESGRIPIIONOFPpOPEPIY�5110WNBELOWON�TTALMFOURCOPIE51 PkOVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> io�_a�oc�or IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTH�RITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUflE OF CONTRACTOR Dil AUTHOflIZEO AGENT OATE <br /> � <br /> X ,r <br /> c�� <br /> PNOJECT��OFE55 APPLILANTS LITY B1151NE55 LICENSE NO <br /> 5�a �.�er� rPa,, �a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%7UNE FEE NO. TYPE OF EOUTAMEN7 FEE <br /> WATER CLOSET ITOILEp AIR COND.UNITS—H.P.EA. <br /> BAT'ri7UB REFRIGERA710N UNITS—H.P.EA. <br /> LAVATORYIWASH BASIN� 601LER5—H P.EA. <br /> SHOWER GAS FIqED AC.UNITS—TONNAGE EA <br /> NITCHEN S�NH 8 DISP. FORCED AIR SVSTEMS—B.T.II. M EA. <br /> DISMN'ASHER WALL HEA7ER9—B.7.11. M <br /> 7AUNDRV TRAV UNIT HEATERS—B.T.U. M <br /> CLOTHES WASNER EVAPORATIVECOOLERS <br /> 1YATEq HEATEq CLOTHES�RYERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN AANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUl1M BPEAKEflS STOVE <br /> ROOP DRAINS—RAIfJLEAOERS METAL FIREPLACE d CMIMNEY <br /> j SINKISERVICE—BAR,ETQ WOODSTOVEiFIREPLACEINSER7 <br /> SUB TOTAL SUB TOTAL = <br /> _ PEflMIT S PEHMIT S <br /> _ TOTAL FEE S TOTAL FEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fRONfSEiBACR qEARSETBAGK SIpE5E1B�CK PL�HGHECHNUMBER PLGNCHECKFEE <br /> N.A• C�n FEE ��� PELEIPi HO (� � �� <br /> USET.ONE LOiAREA �w Q f(= <br /> VAL�A'TSITE FEES VALUATION FEE <br /> /J�A• N.k• oYES,�NO <br /> TVV�OF CONSi OCCUP�NLY GROUP NO�OF DWELLING UNITS I S <br /> � � ��2 U BUILDING S�u�, y �/ <br /> SIZE OF O�D/G/� NO OF STOFIES MAX.00G LOAD � <br /> �/(ilJ S� I 3S PLUMBING <br /> MECHANICAL <br /> FIRc SPRINKI.EHS FEOUIRED ❑VES NO <br /> OfHER <br /> PENALTV <br /> •PPLIC4710N ACC UY PIANS CHECNE�BV APPR.FOfl ISSUANCE BY � — <br /> T0TI1L 7 C, <br /> Y�1 W� ✓E� � �G <br /> _ �G:ti� ��'�-P-4 � �.lf�� /�✓irlT <br /> Tv f�.�E: O1�,aT,�r�.rr;<; l� <br />