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`;�::PPLICATION FOti�' <br /> �°"""" CONSTRUCTION everell <br /> everett PERMIT e <br /> BUILDINO DEPARTMENT <br /> 269•8746 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION O COMBINATION ❑ BUILDINQ �MECHANICAL ❑ PLUMBINO O 81ON <br /> OWN[ �I.�.M /y• M�II�pORf!! G1IY !IP P110NE <br /> �OWN/ I � • <br /> 1111GX1�lG�W1pE�nCw MI111110OFEB8 CIfV IIP PNONE <br /> OEMEMIC IIU1GfOR MMl�00AE68 �� CIIY IIP PMONE LICEN6E• <br /> D ..S�c� — � $p ' _ <br /> MtGHM! f�0 IMLiOq M�ILIDURE!! CITY IIP PNONE LICENlE• <br /> �r 'sJ <br /> rIUWINOCONT14Cip1 MqL�DONE!! CIfY TIP PIIONE IICE ! • <br /> Of YqI1K <br /> NEW ❑ AOOI710N ❑ ALTERATION ❑ HEPAIR ❑ OEMOLI�ION ❑ W0009TOVE/FRPL.IN9ERT ❑ BUILDINO PELOCATION <br /> wu�r a�or M�r[nu�s owa usan <br /> f911-Q° <br /> a�em�e wo�K � <br /> C � V J <br /> u�e a waomo <br /> C I HEAEBY CERiIFY THAT I HAVE READ AND EXAMINED THI8 AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> llOKD[OLM►flqlqMOPlM��ONOWNlEIOWOR�TTACNfOURCOlYE81 ppOVISI0N90FLAW3AN00RDINANCES00VERNINaTHIBTYpE <br /> UF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> ioi_Koc�or_ IN OR NOT.THE ORAN?INO OF A PEHMIT DOE8 NOT PRESUME TO <br /> UIVE AUTHORIIY TO VIOLATE OR CANCEL THE PpOV1810N9 O� <br /> ANV OTHER 9TATE OH LOCAL LAW REOULATINO CON9TRUCTION <br /> OR THE PERFORMANCE OF CON3iRUCTION. <br /> 810N�iURE OF LON� CTOR OR AUTNORI2EU AOENT OATE <br /> X , 0 � <br /> rwxer�oo�ees��,j W �vvu r ertreus�Heanircexs <br /> �M��� MtCNANICAL <br /> N0. T'N OR fIIITUII! i[! NO. N�!Of[OUIMItNT f[! <br /> WATER CLOBET tOIIE AIR COND.UNITB-H.P.EA <br /> CATMTUB REFq101NATION UNIT9-H.P.EA <br /> LAVATORY WABH bA81 BOILER9-H.P.EA <br /> 6HOWER OA9 FIRED AC.UNITB-10NNApE EA <br /> I(ITCNEN 81NK�DIBP. FORCE0111R BYBiEMB-B.T U. M EA <br /> DIBHWABHER WALL HEATERS-B.i.U. M <br /> LAUNORYTMY UNIiNEATER9-B.i.U. M <br /> CLOTHEB WABMER EVAPORATIVE COOlEH9 <br /> WAtER HEATER CLOTHEB DRYER9 <br /> URINAL VENTILATION FAN <br /> DRINNINO FOUNTAIN qANOE HOOD <br /> f100q OR�IN AIR HANDLINO UNIT- C.F.M. <br /> VACUUM BNEAKERB 9TOVE <br /> ROOF DMINS-RAINLEADERB METAI FIREPLAC6l CNIMNEY <br /> 81NN BERVICE-BAR ETC. Wp009TOVE/FIREPLACE INSERi <br /> I <br /> L � <br /> i � <br /> �U�TOTAL eUlTOtAL • <br /> �lIIMIi t Pt11M1T � <br /> _ TOTALf[E • TOTALFE[ • <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> f110NT6ETMCN NEARlETB�CIt &OEBETBACN PL�NCNELItNUMBEN VL�HCNELefEE <br /> !EE PECEIPTNO <br /> U6!=OHE IOi�REA y���NilIIE <br /> �YEB ONO �[!D V�LU�TION I!! <br /> T'VEOlCONDT. OGGIIV�NCYGNOUP NOOFOWEtLINOUNR9 <br /> BIlIL01N0 f <br /> 612E Of BLDO NOAillONlEb MeX OCG 10�D <br /> PLUMBINO <br /> MECIUNIC�L � <br /> FINE SPPINNLERS REOUIRED O YE9 ❑NO <br /> OTHER <br /> FEN�LTY <br /> AVFLIUfION11GC.BY FL�NSCNECMEUBY �pPR.fOR193U�NCEBY _ <br /> GG .o..� <br />