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�,;.Ew,o�.� �►�PPLICATtUN FOR� ' ���,�„ <br /> ��n�F CONSTRUCTION 0 <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATiJN ❑ BUILDING � MECHANICAL ❑ PLUMBINO ❑ SIGN <br /> OWNER /� ,/ M�ILAp0AE53 /J CITY 21P PMONE <br /> T.. �7��Y !"��n�C9 I.3I / /�YOGs�ff�Uc/ li�C/ � <br /> MCHIIEGTORDE5i0NER M�IUO�RESS CIiY ZiP VHONE <br /> OENERALCONiRI1CTOR MML�DORESS CITY 21P PIIONE 4CENSE• <br /> MECIUNIC�LCOI:fR�CTOfl M�IL1100RE59 C�I�TY 21P PMONE LICENSE� <br /> /��.�� �� �u.,.o� lns S79 S� �✓ai-z�7`- T7'.�� l(�a.y .�vric� .JS i=77s'0' <br /> PLUMBINOCIItR�CTOR M�IL�DORE59 Cltt iP PNONE UGENSE• <br /> CU55 OF WOFK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�W�TiON OF WORR IC09T OF MMERi�t9 PLU9 L�BOiry <br /> OESCPIBE wORK �[ ��� / <br /> � PT G(/t�✓ [4.�!/ ' /' p. �� <br /> USEO UILOINO <br /> I HEREBY CERTIFY THAT I HAVE READ AN� EXAMINED THIS AP• <br /> PLICATIONAND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> LEO�LDESCRIPTIONOFPHOPEFTY�SHOWNBEL�WOR�TfACHFOURCOPIES� pqOVI510NSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WIiH WHETHER SPECIFIED HERE• <br /> LOT_BLOCK�OF IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANY OTHEfl STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNA:UFEOFCONTAACTORORAUTNORIZEDAGENT DATE <br /> x � � i% - i/ G �' �� <br /> PROJEGi�00RE5S p AP IC�NTSCIiY N HESSIIC <br /> /.3/9 /� aae•C�ve_ vz�e -- <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTUHE FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET TOILEI) � AIR COND.UNITS—H.P.EA <br /> BATHTUB REFflIOERA710N UNITS—N.P.EA. <br /> LAVAtORY1WASH BASIN) BOIIERS—H.P.EA. <br /> SHOWER GAS FIRED 0.C.UNITS—TONNAGE EA <br /> K�TCNEN SINKB D�SP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> OISHWASNER WALLHEATERS—B.T.U. M <br /> LAUN�RYiPAV UNITHEATERS—B.T.U. M <br /> CLOTHES WASI/ER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES OHYERS <br /> URINAL VENTILATION FPN <br /> DRINKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BFiEAKERS STOVE <br /> ROOF DRAINS—FAINLEA�ERS METAL FIREPLACE 8 CHIMNEY <br /> SINK SERVICE—BAR.ETC. WOOOSTOVE/FIREPLACE INSERT <br /> � � <br /> SUBTOTAL SU9TOTAL S <br /> PERMIT f PEPMIT S <br /> TOTALFEE f TOTALFEE 3 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FNONT: .d�CK REARSEIBAGK SIOESETBACN PLANCNECKNIIMBEII PLFNQ�ECItFEE <br /> iEE �ECEIPt NO. <br /> USE 20NE lOi RRE� y�CRNT SITE <br /> FEES VAIU�TI�N FEE <br /> OYES ONO <br /> ttPEOFCONST. OLCUPANGYGROUP NO.OFOWELLINOUNIT9 <br /> BUILDIN� E <br /> SIiE OF 6lUQ N0.Oi StONIE9 MRX OCG LOPO <br /> PLUMBINO <br /> MELNANICAL <br /> FIRE SPRINKLERS R[OUIRED ❑YES ❑NO <br /> OTHER <br /> PENALTV <br /> MPLIC�110"ALG DY PUNS CNECNED BY RPPP.FON ISSU�NCE BY <br /> TOTAL <br />