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�-�. <br /> ��.E�ro,�� �=�.PPLICATION FO��-�� ���,�„ <br /> GTM�F CONSTRUCTION e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �.MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNEH M�IL�DDRESS C�n' ZiP GMONE <br /> �1�lI�1 fl,,..,..� „ 1<`�I� I-Ir�nif-} AU� crU�'cf-f- � �i��c. -:�?�. - �'rll <br /> �RLN1�ECTOR�ESi ER M�iI�DDPE55 Cltt 21P PNONE <br /> GENER�IGONTR�CIOR MAILADORE55 GTY ZIP PNONE LtCENSE• <br /> MECN�NiULGONiR�GTOfl M�IL�ODNESS CITY ,n 21P PNONE 4LENSE• <br /> �b�P1�•i�z�/� ��t� ,h.:��i1L-l:�f•fn� . f�.0.r�•,(-I�o� i'.U�R��7' �PG(Y. .��.�.� :�lli� /'��!!'�'::'i. !.� <br /> PLUMBINOCONTP�CiOR MAILADDR[55 GITV ZIP PI�QNE UCENSE <br /> CL�55O�WORK <br /> m NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCl+TION <br /> V�LWUION OF WORN�COSIOF M�fCRIRlS PWS LRBONI <br /> DESCPiBE WOHN <br /> .� I�r ( � ' 1 <br /> useore iiano ' - I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS AP• <br /> PLICAiION AND KNOW THE SAMETO BETRUE AND CORREC?.ALl <br /> LEO�' RIPIIONOFPROPERTY�SHOWNBELOWOR�TTI1CHf0UNLOPIE51 pROVISIONuOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or_eioc�_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF <br /> ANY OTHEH STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> E OF CONTqRCTOR UR AUiHOAl2EU AGENi DnTE <br /> �c � DZlr�� S aG d�-. <br /> PPOJECT�DDRE55 A U 5 i V�OSMESSLIGEN NO� <br /> ,l r�riicaclU'u.t �' ��c'_�. .1a1 . <br /> PLUMBINO ' MECHANICAL <br /> NO. TVPE OF FIXTURE FEE NO. T'PE OF EOUIPMENT FEE <br /> WA7ERCLOSET TOILE AIRCOND. UNITS—H.P.EA. <br /> BATHiUB REFRIGERATION UNITS—N.P.EA. <br /> LAV�TORV�WASH BASIW BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AQ UNITS—TONNAGE EA r(.; . _ <br /> NITCHEN SINK 6 DISP. FOHCED AIR SYSTEMS—B.T.U. M EA. _ <br /> DISHWASHER W�LL HtATERS—B.T.U. M <br /> LAUNDRVTRAY UNITHEA7ER5—B.T.U. M <br /> CLOTMES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES ORVERS _ <br /> URINAL VENTILATION FAN <br /> DRIIJKINQ FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIH HANDLING UNIT— C.F.M. _ <br /> VRCUUM BREAKERS STOVE _ <br /> ROOF URAINS—RRINLEADERS METAL FIREPUCE 6 CHIMNEV <br /> SINN SERVICE—BAR ETC. WOODSTOVE/FIREPLACE INuERT <br /> SUB TOiAL SUB TOTAL 3 1 <br /> PEflMIT f <br /> PERMIT S �+ � <br /> TOTAL FEE 3 TOTAL FEE _ �-- <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iROHT5E7B�CN REMSEIBACN SIDESETBRCK PLANGNWKNU�IBER PUNCNECn1EE <br /> FEE RECEIPf NO. <br /> USE20NE LOiAPE� y�C�NT51iE <br /> FEE9 VAIU�TION FEE <br /> OYES ONO <br /> TYPEOFCONST. OGCUPANLYGROUP NO.OFDWElLINOUW�iS <br /> ouaoirva s <br /> size ov sioa. r+o.or stonies Mez.occ.iono <br /> a�un+oinc <br /> MEClIANICnL .. �L� <br /> FIRE SPRINKLERS REOUIREO ❑YES ❑ NO <br /> OTIIER <br /> PENALTV <br /> APPULAlION�GC.BY PL�NS CNEGNED BY APPR.FOR ISSVANCE BY <br /> � TOT�L C � � <br />