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�I <br /> ,�.E,.,o,,,� - APPLICATION fl� R evcretl <br /> °�tt°F CO(`1STRUCTION <br /> everett PERMIT e <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWI1f.R / MAI�ApDNE55 / GIV IIP PIIpNE � <br /> `�C� �hY�/�7 V:,S I509 — LL� �r.1te��i ./ i �� �i5-9 "1`/Jl� I <br /> �ncwier,ronoesicr+ M�iLA0DRE55 c�r rm i���or¢ <br /> GENERLLCONTRACTOA MRRAODRE55 �ItY ZiV ���ONI VL[NSE• <br /> IAELHI/NI/CALLONLf1AC�ON.� /AUIlA0DRE55 �d/IY piP VUUlq ����rySE� <br /> L�11�� [ //�✓C / /�C% S' .h �% .5��. �iirs�r// �In��l���/ C�rvr� 1S S 7� 0 <br /> PI'iNAiNi UHiR�C10R �fAI�AO�RL55 CIIY pi P��ONC ItCCllSf• <br /> CL�^vSOf WOPN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DE1.10LITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIIJG RELOCATION <br /> VnLU�110N O�WONM ICOSi OF MRTERIAL51'W 5 LABORI <br /> UESCRiBE WORN <br /> � ' <br /> J�s7�� ��ar /�r.<nnt/in, CJ� � �n�e. ._G�� 7� �� �es � � /(% y/ �nn� <br /> usE or euaou+c <br /> I HE�;EDY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLIC�TION AND KNOW THE SAME TO BE TRUE�ND CORRECT.ALL <br /> LEGALD[SCRIP11pNOFPpOPERiY�5110WNBElOWORRI1ACNi0URCOP1E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COh1PLETED WITH WHETHER SPEGFIED HERE <br /> io�—eioc�or IN OR NOT.TH[GRANTING OF A PERMIT DOES NOT PRFSUtdE TO <br /> GIVE AUlfiORllY TO VIOLATE Oli CANCEL TI�iE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW RGGULATING CONSTRUCTION <br /> OR THE PERfORMANCE OF CONSTRUCTION. <br /> SIL'NAiUR[OF ON1RnCLOROHFlIi/10RVEDf�l3��� DAi[ <br /> X „ / <br /> / � / A � / ' <br /> ��',�J'�/�---_ <br /> apol[tr noDREss /J aV1�U(qNrS Grv Bus�NESo:�Cc�N5�N6' <br /> / ��C L' ��'r �� !/ <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOII[T) AIR COND UNITS-11 P EA. � <br /> BATHTUB R[FRIGLRATION UNITS—I/.P.EA. <br /> LAVATORY�WASH BASIN) BOILERS—NP EA. <br /> SHOWER GAS FIR[0 A.0 UNITS—TONNAGE EA <br /> _ KIiCHEN51NK8DI5P. �ORCE041RSYS�E1.15—O.TU 67EA._�C1A'1 _ _ <br /> f—\ <br /> DISHWASHER 1VALL MEATERS—�7.U. M <br /> LAUNDRY TRAY UNIi HFATERS—BT.U. M <br /> CLOTHES WASNER EVAPORATNECOOLERS <br /> WATER HEATEF CLO711ES Of7YER5 <br />� 11RINAL VEIJTILATION FAN <br />. DRINKING FOUNTAIN RANG[HOOD <br /> FLOOR DRAIN AIR IIANDLING UNIt— flF.M. <br /> VACUUM BREAKEFS SiOVE <br /> ROOF DRAINS—RAINLEA�ERS METAL FIREPLACE 6 CHRdNEY <br /> SINK SERVICL—BAF,ETQ WOODSTOVE/FIREPLACE INSERT <br /> f , cc�, _r��•�� -- -- <br /> SUB TOTAL SUOTOTAL S <br /> PERMIT S PERMIi S <br /> _ TOTALFEE S TOTALFEE S � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> IpON(SEiBeCN BE�NSEIBAGN SIOES[TBACK VL4NCIIECKNUTApCN �'V�1C�rtCe�fl. <br /> . F[E �CC[lVfNO <br /> WFZOH@ IOT�RE� VPCANi51iE — -- — <br /> ❑VCS pN0 F[E9 VRLUATION i[E _ <br /> fVPEOFLONSi. OCCUPANGYGROUP NOAFOWELlINOUNITS <br /> OUIlOIN� E <br /> SIZE OF BL�O NO.OF STORIES AIAX OLG LO/D <br /> PLUAIDING <br /> MECIIANICAL <br /> FIRE SPRINKlERS REOUIRED ❑VES ❑ NO — — <br /> oi11ER <br /> P[NAL1Y <br /> p:'r4CApONACC.BY FUNSCNEb�'DBY �PPRFONISSUANL[OY --- —�— <br /> TOTAL — — <br />�.. ' 1 <br />