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,�.E„ro�,� '.,PPLICATION FO�;w ���,�„ <br /> °m°f CONSTRUICTION <br /> everett PERMIT e <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBINO ❑ SIf3N <br /> OWNEN M�IL�DORESS �pY zIP PNONE <br /> �Ar �/PAv _N (�ll-c��dv �! Ey�f� Q�a3 �3- � !�. <br /> �RCMIIEGTGqpEB��NEF MAR �DURE�i�� qTV ZiP PNONE <br /> OENEML GONTH�CTOH M�IL�DDRESS Gtt [iv PNONE �ICENBE• <br /> �/GB,E1T ��A'S 7�l�' yAGYo FI/f-rPL EL �/t�� 9�.�L1? s������ <br /> MEGH�NIL�L CONTR�GiOq MML�CDRE..5 GitY 2iP PrONE UCEN4E• <br /> EY-��°-t8-�'3-//�.3 <br /> PLUMBINOCONiR/1CTOR MAIL�DORESS G�tY SiP PHONE L�CEN9E• <br /> CL11990f WORN — <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WUOUSTCVE/FRPL.INSERi ❑ BUILDINQ qELOCATION <br /> V�WITIOH Ui WORI(�COSt Of M�iFR1.118 PW 9 L�BORI <br /> �L�[/F.UG <br /> DE9CqIB W RK � <br /> • <br /> U9E F BUILOINO � <br /> �� ` I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> ' � PLICATIONANDKIJOWTHESAMETOBETRUEANDCORRECT.ALL <br /> �eoe�oe IPTIONOFPROVEPTY�9M0 NBEIOWOR�TTACNFOUPCOPIE& PROVISIONSOFU\WSANDOHDINANCESOOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEq SPECIFIED HERE- <br /> �or_e�oc�_or IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> / �.'.� �/ GIVE AUTHORITY 1'O VIOLATE OR CANCEL THE PROVISIONS OK <br /> MI / ANYOTHERSTATEORLOCALLAWREGULATINOCONSTRUCTION <br /> OR THE PEFFORMANCE OF CONSTRUCTION. <br /> � .^� � ".� SION�TUR OFCONiR ONORAUTHORIZEDAOENT D�TE <br /> X � � <br /> a <br /> PNOJEGTi1D��99 � � �� �pp��L�NTSC1iY ❑ iry ENO <br /> �� <br /> PLUMBINQ MECMANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSE7 TOILE AIR COND. UNITS—H.P.EA. <br /> _ BATMTUB REFR16ERATION UNIiS—M.P.E�. <br /> LAVATORV WA9H BASIN BOILCR�M.P,EA. <br /> 9HOWER OAS FIRED AC.UNITS—TONNAOE EA <br /> NITCHEN SINNB D19P. FORCED AIR SYSTEMS—B.T.0 M EA <br /> _ DISHWASHER WALLHEATERS—B.T.U. M <br /> _ LAUNDRVTRAY UNITHERTERS—B.1U. M <br /> CLOTHES WASMER EVAPORATIVECOOLERS <br /> WATERNEATER CLOLHES DRVERu <br /> URINAL VENTILATION FRN <br /> ORINKINO FOUNTAIN RpNOE MOOD <br /> FLOOR DRRIN AIR HANDLING UNIT— CF.M, <br /> V1ICUUM BREAKERS STOVE <br /> ROOF ORAINS—RAMLEADERS METAL i'REPLACE 8 CHIMNEY <br /> SINK 9ERVICE—BAR ETC. WOODSTOVE/FIREPLACE INSERT <br /> BUB TOTAL BUB TOTAL f <br /> PERMIT { PEHMIT { <br /> _ TOTALFEE t TOTALFEE � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iNONTBETB�CN RE�N6EiBACM 91DE9EiBACN PL�N CMEGM NUM9FR v��NCHEChfEE <br /> fEC HECEIPifiO <br /> UBEZONE I.OiANE♦ y���Nt9iTE <br /> ❑VES aN0 FFE! V�LU�TION F![ <br /> fYPEOiCONST OCCUP4NCYGROUP NOOfOWELLIN0UNl19 <br /> BUILOINO S <br /> BRE OF B100 110 Ui BTOPiFS M�K OCC IO�D _ <br />, PLUMBING <br /> MECN�NIC�I <br /> FIRE SPRINKLERS FEOUIRED ❑ YES [J NO — <br /> OTHER <br /> PENALTY <br /> APPLiC�110N�CC Bv PLANSCNEGNEO 9Y �PPR iOR 193UANCE BY __ <br /> TOT�L <br />