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�'��PPLICATION FOt �' <br /> ,`.. 0 <br /> ��'°'"" CONSTRUCTION �`°`"' <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑COMBINATION ❑ BUILDIN(i ❑ MECHANICAL ❑ PLUMBINO �81(iN <br /> CWNER NML�U011E5! LITY 21P IMONE <br /> `7�1� `�r�� 4ZAt� ic �I�] C_'l�na�v�' VirA�' Q�cJ2e37�— � <br /> IIRLNITECTON�ES�ONEN M�IL�DORE88 CIIY 21P PMONF <br /> OENEML CONTp�IOR M�It�ODREB! CiIV ZiP PHONE LICENB[• <br /> �7'�.7P� �{L�' �C�..ZS �l/£�l2c37T w.4 c�S'� G�£7� 'TUBc A31 I(sl �1K <br /> MECX�NIG�LCONTMCtOq M1R�OORE89 tlrv )�P PHONE IICENlE• <br /> PLUMlMOCONTR�Gidl M�tL�00RE6! CITY Z�P %�ON[ IICEN9F• <br /> ClA6!OF WOIIN <br /> �NEW ❑ ADDITION ❑ ALTEI7�TION ❑ REPAIR ❑ UEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUIlDINO RELOCATION <br /> V11W ONOfWORIt1��STOfN�TEPI�L6PWlL�OOM I <br /> � ilYl <br /> 7� <br /> DElCRilE W011K <br /> �✓sr�kc--�vs-rao+a�s Siv�v �ro Cxc.+�v�oh� '�+,.ti ar- �3�r�c> n'za�n-�c�. <br /> use or aw�oixa <br /> I HEREBY CtiiilFY ii��1' I HAVE REPD AND EXAMINED THIS AW <br /> PLICATIONANDKNOW THG 3ANriE Tf�BETRUEANDCORRECT.ALL <br /> LEO�L�flCRIPIIONMPROPENIY�SNOWNOEIOWOP�I1�CHi0U8COPIEB� pROVISIONSOFLAWSANDORDINANCE360VERNIHnTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIEO HEFE• <br /> �oT_e�oc�_or IN OR NOT.THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REOULATINOCONSTqUCTION <br /> OH THE PERFORMANCE OF CONSTRUCTION. � <br /> SION�TUREOF C10POR iHOF�2E�NT 011TE <br /> X <br /> ■PQIEGt�00PE66 �PPLIC�NTBpfYBU9iNE �CENSENO <br /> �ot w�f. �.�arr. <br /> �LUM�INO MECHANICAL <br /> M0. TYiE OF FII(TUqE F[E N0. 7YPE OF EOUIPMENT FEE <br /> WnTER CL09ET TOILE �IR COND.UNITS—H.P.EA. <br /> BATHiUB REFHIUERATION UNItS—H.P,EA. <br /> UVIITORY WABH BA91 BOILER9—H.P.EA. <br /> BHOWEI7 C119 FIRED AC.UNIT9—TONNAOE EA <br /> KIiCMEN 81NN 6 D19P. FORCEU AIP BVSTEMS—B.T.U. M EA. <br /> DIHHWA9HER WALLHEATERS—B.T.U. M <br /> LIIUNORV TRAY UNIT HEATERS—B.T U. M <br /> CLOTHE9 W�9NEN EVAPORATNE COOLERS <br /> W�TER HEATER CLOTNEB DRYER9 <br /> UNIN�L VENTIUITION FAN <br /> ORINKINO FOUNTAIN pANOE HOOJ <br /> FLOOR ORAIN AIR MANDlll70 UNIT— C.F.M. <br /> VIICUUM BREAKER9 $TOVE <br /> ROOF�MIN9--RAINLEADER9 METAL FIREPL�CE 6 CHIMNEY <br /> BINI( BEHVICE—BA ETC. WOODSiOV6FIREPLACE INSERT <br /> tUe TOTAL 6U!T0TI1L � <br /> I PEIIMIT • PEIIMIT i <br />�. _ TOiALfEE • TOTALFEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> i110NT�ffMClt NE�RlETl�CIt QDlOEIMCR VL�HCefCMNI1MBEP R.INCHECKFEE <br /> fE! RECEIPT NO� <br /> UlE20NE IOT�RE� y�C�I1TlAE " <br /> ' OYE! ONO f[[t V�LUITION f�l <br /> IYPEOfCON6T. OCCUP� CY6pOVP NOOFDWEIUMUUHIi9 <br /> BUILOINO f ' <br /> !IL[O!lLOQ NO.OF piOPIF! M�II OCL.LO�O <br /> PLUMBINO <br /> MECN�hIC�L <br /> FIRE PRINKLEF9 REOUIRED O YE9 O NO <br /> OTHEP <br /> PENALTV <br /> �VP4C�110N�CC.BY PIAN!CHECMEO BY �Pi0.FON IBBU� <br /> � � TOTAL — <br /> � ���v� <br />