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`��;PPLICATION FO►.�� ���.�„ � <br /> '".`"'°"'° CONSTRUCTION 0 <br /> art or <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMB�NATION O BUILDINd O MECHANICAL ❑ PLLIMBINO �SI�N <br /> pµryEp MAIL�OORESS CIiV bP FNONE <br /> �I,u� l�{c��U_C.�v i 3 31 �3ne�u���r.i� n�,�-- r2tSa.�T �l sv-35'�3 <br /> •HGMIIECIORpE5101�ER MeILA00RE53 �G ' Z�P PNDNE <br /> GENERALCOMF�GIOR MMlA0Df1E55 GIfV 21V PHONE 5���(rPO <br /> G(F-A) `fi , F-/ / ! s/L-.VOL <br /> J L I I? 5i GN >o.� Fl � �� �F,c�c-wcth0 u,74 414U3� � 7y-�&S''� .s�..�ur <br /> MECN�HIUIGONI�eCiOq M�II��ORE59 ���� =�P PNONE 4CCNSE• <br /> PLUMBINOCOHIR�C�OR MML�0011E59 CITY ZIP VNDNE L�C[NSE• <br /> Cl�SSOf WDRR <br /> �, NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCA110N <br /> V�lU�l10��O!WO(1N�C09t Of 1A�iC��µ9 PLU9 L�BOPI <br /> r� 5�� �—' � <br /> OC4LR�BE WORI( <br /> 5M a! � ,,,o��i7al,c� /aR .utbx� D F � ! (a � 5 /Cv�.�/ — c 9 � 7�- <br /> us�e or7�emioirvo I HEREBY CERTIFY THAT ; HAVE READ AND EXAMIN D THIS AP- <br /> / /iVr� )l� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> 1E0�[DESLRIPIIONOFPq04'ERiVI511OWN0ElOWOR�111CNi0URGOt'IESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WliETHER SPECIFIED HERE� <br /> tot_e�ot�—or IN OR NOT.THE GRANTING OF A('ERMIT DOES NCi PRESUM1IE TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER ORLOCALLAW�F ULATINGCONSTRUCTION <br /> OR THE FOR ANCE OF C�RU ION. <br /> SIGNAT E OFCONT RCTOR NdU RGENT DATE <br /> X _�- �_—"t"e' �`�-� <br /> PAOJCCI�fIDllE55 / A IG NTSCIIYBUSME59lICEN5EN0 <br /> �3J� �l't07�lA[c�Yl L'-` EZK�72 r�7'_ <br /> VLUMBINO MECHI1NICl1l. <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> Wn1ER CLOSET�TOILED ���COND. UNITS-N.P.EA. <br /> BATNTU9 REFRIGERAtION UNI75-H.P.EA. <br /> LAVATORV�WASH BASIN� BOILERS-H.P.EA. <br /> SHOWER GAS RqED A.Q UNIB-TONNROE EA <br /> KITCHEN SINK 6 DISP. PORCED AIR SYSTEMS-B.T.U. M EA. <br /> OISNW�SHER WALLHEAIERS-B.T.U. M <br /> LAUNDAVTi7AV UNITM[A7ER5-B.T.U. M _ <br /> CIOTHES WASNER EV/.PORA7IVELOOLERS _ <br /> WATER HEAIER CLOTNES ORYERS <br /> IIRINAL VENiILATION fAN <br /> ORINKINO FOUNTAIN RAN6E HOOD � <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> f700F DRAINS-f7AINLEAUEf7S METAL FIREPLACE h CHIMNEV <br /> $INN�SERVICE-BAR E7C� WOODSTOVE/FIREPLACEINSERT <br /> SU9 TOTIIL SI1B iOT�L f _ <br /> PERMIT ! PEHMIT f <br /> TOTALFEE { TOTALFEE • <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fqONf5El0�CK P[AfI5C�04GN SI�ESELB�GN �UNGNEGNNUMBEP 1'I�NGNECRIEE <br /> fEE f1ECEIPI NU <br /> USE ZON[ IOIAOf� y�C�NiSttG <br /> FEES VALV�TION FEE <br /> pYE3 ONO <br /> TYPE OF CONST. OCGUP�NLY GBOUP NO.OF DWEIIINQUNIB <br /> BUILOIN� S <br /> SKE Of OLDO NO O�Si0111E5 M�K OCC.LOAD <br /> PLUMBIN6 <br /> MECHANICAL <br /> F�RE SPRINKLERS FEOU�RFO ❑VES O NO <br /> OiHER <br /> H PENALTY <br /> APFlIC�110NnCC0Y 1'UNSCH[CNEOBY �PPR.fOPI55U�Nc � <br /> LGy�C�� 1'OTAL _ <br /> �>. ' <br /> 11` <br /> l� <br /> ��� <br />