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i <br /> � ., 1^ <br /> IJ I/1J A <br /> �...�1PPLICATION FG-.� �e <br /> ,^'`�'°'"" CONSTRUCTION � <br /> un or <br /> everett PERMIT <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259-8745 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING �SIGN <br /> M41L I�DUAC54 G�N Z�F �NONC (] q <br /> OWN[P _ ll . .A ZJL��-1��7 <br /> sr�nNus �+n�a � s�<n�cr�z�ctrc�k2 ;azc� e�n-�,a.� � <br /> Zp roc <br /> �n�wiCLlORplS�ONER M�IL�DOREHS "' <br /> � �y,� o� _ o rv�c 33o LyN„"'u'c! y8o4� 1072.-�t4Ss <br /> J�C 11C ��`�' � MMLAODRE55 CIiV 21G � O C �ITY LLC VE <br /> fiEN[R��GONiR�GIOR �1 �, (. � � OF 3Z��S <br /> Il <br /> MEGN�NIUI CONIR�C10? M�IL WDRESS <br /> GIiY ZIP PNONE UCCNSL • <br /> PW MBINO GONIP�GIOR <br /> MGILApD�E55 Cltt 210 P��ONE l�C[NSf � <br /> C1�550f WORK <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIii ❑ DEMOLITION ❑ WOODSTOVE/FFPL.INSEFT BUILDING RELOCATION_ <br /> wLU���ON 01 V/OAK IClO51 Of M�1CHi�LS FW S I�BORI <br /> I �O v <br /> Ul9GRi6E wORK (� �� �Z�V LN�I��eQ <br /> � N$1Q � � ✓L t71�' S 1 Ll <br /> usc or ew�oieo I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS AP• <br /> PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br /> L[O�lDCSGA— �P1��H��PA��ERfv19NOWNBELOWOR�TI�GHFOURCOPtes� � OFWOR�WIL�BE OMPL�EOWITFNWHETIi�EFSPECFIEDHERE• <br /> �a�.�B�a�K_o� I IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> I GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW P.EGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OP GONtBAGTO�OA AUT110A�ZED AGENI DNE <br /> X � . � �� � �'(, <br /> — IIPPLICRNTSQtY8U51NE55LIGENS 1�6 <br /> PROJELT�ODRE55 �gq �� <br /> 34z�o Broad�a <br /> MECHAN�CAL <br /> PLUMlINO rypE OF EOUIPMENT FEE <br /> MO. TYOE OFFIKTURE FEE NO. — <br /> AIR CON�.UNITS-HP.EA. <br /> WATEA LLOSET(101LEA <br /> PEFiiIGERATION UNITS-HP.EA. _ _-- <br /> BATMTUB — <br /> BOILERS-HP.EA. -- <br /> U�ATORY WASH BAS�N� <br /> GAS FlRED AC.UNITS-TONNAGE EA __-__ <br /> fiHOWER <br /> fORCE�AIR FYSTEMS_B.T U. M EA. -- <br /> NITCNEN S�NN 8 D�SP. <br /> WALLHEATEHS-BT.U. M <br /> DISHWRSNER <br /> — UNIT HEATERS-B.T.U. M .— --- <br /> �AUNDRY7FAY <br /> EVAPORATNE COOLEFS -- <br /> CLOTN[S WRSHEH CLOiNEFDRYERS --�-- -- <br /> W�TER HF�TER <br /> VENTILAiION FAN -- <br /> UA�NAL _ <br /> pANGEHOOD -— <br /> ORINNINO FOUNTAIN <br /> AIP HANDLING UNIT- GFM, _—_— -- <br /> fLOOR DRAIN S10VE - <br /> VACUUM B�7ERKERS .. <br /> ROOF DFAINS-NA�NLEADERS MEIAL FIPEPLACE 8 CHIMNGY - --- <br /> WOODSTOVE/FIREPLACE INSERT .— --- <br /> SINK ISERVICE-BAR.ETC. __ <br /> SUB TOTIIL = -- <br /> SUB TOT�L PERMIT S -- <br /> PERMII � f <br /> TOT�LFEE �-�-- - <br /> TOTAL FEE � ._ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL _ <br /> PL�N LHEGN NUMBER <br /> ot�N G�[Gn rEE <br /> �AO���SE�B�GN �W�SEIBACN SIDE5EIB�GN p[CEIOiNO <br /> fEE <br /> USC20NE lOt�f1E� yp��NTBIIE iEE4 VAWATION iEE _ <br /> pYE9 ONO <br /> 1YP[OfCON9f OGLUPRNGYGPOUP NO.OfDWELLIN0UNR3 — <br /> UUILDINO s -- <br /> S2E Of BL06 NO Oi S10RIE4 M�N OCG LO�D <br /> PLUMBIN� -- <br /> MECHANICRL -- <br /> fiRE SPn�NHIERS REOUIRED ❑YES ❑ NO orHen -- <br /> PEN�ITV � -- <br /> �CPLIWtION�CL BY PUNS GH[GREO BY APPR FOR ISSUANC Y � <br /> TOT�L - <br /> �, <br /> �ZC-�6Cp <br />