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�'�_�:PPLICATION FO��°' <br /> '^��"'° � CONSTRUCTION "e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIfiN <br /> OWMEP MAIL�DONE9S �ITY zlP PNONE <br /> JoN.�.AND �o^�,At,t��1 ��� q�l ��Gv9/�_ <br /> �NCNRECTORDESIQN P MLILApORE59 �IIY iP � �NON[—� <br /> L i <br /> %�� <br /> OEMEF�LCONiRAC10H �� MAiL^ppqC59 � ��fv �ZIp. I �� � IIGENSE• i <br /> /� %/JtYD lLJ 1/Y 1%� ViIIFY <br /> ��-�y/y-}� (i//! /11/Ilil f V Ir <br /> MECNIINIC�LCA T dOP�1 1� MAIL�ODRESS LITY ZiP PIIONE ���� <br /> PLUMLIN6CONiRACtON M�IL�DDRESS LITY 2iP PMONE UCENSE• <br /> CUSB�F WORc ,�J <br /> ❑ NEW ❑ ADDI7IUN XJ ALTERATION ❑ REPAIR ❑ DEMOLiiION ❑ VJOODS70VE/FRPL.INSERT ❑ BUIlDINO FELOCAT�ION <br /> U 11TION OF WORN�W91 OF M�1ENUl5 VLV9lA60R� <br /> ����� <br /> Df:pCPiBF WORR <br /> X — a' <br /> '�,�. .�T nsr�-s , <br /> �or su��oina I HEREBY CERTIFY THAT I HAVE READ .• ExAMINED THI3 AP- <br /> �� � • PLICATIONANDKNOWTHESAMET08E EANDCORRECT.ALL <br /> LECAIDESGRIPTIOHOFPROPERTY 'N OWOR�TT�CNFOURCOiIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTYPE <br /> OF WORK WIIL BE COMPLETED WITH WNETHER SPECIFIED HERE• <br /> ioT_eioc�—or IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> - GIVE P.UTNORITY TO VIOLATE OR CANCEI THE PROVISIONS OF' <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION I <br /> OR THE PERFORMANCE OF CON�TRUCTION. , <br /> SIGNA7UPE OF CONTRACiOR OR AUTNORI2C ENT DAiE <br /> X - � <br /> 7�3-8� I <br /> PPWECT�ppFE59 �PPLIC�NTS CITY BUSMESS LICE ISE N I <br />! 'z- boq . \b �� <br /> �LUM�INO MECHIINICAL I <br />� _MO. TYVE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE i <br /> WATER CLOSET TOILE AIR CONO.UNITS–HP.EA. � �. <br /> i BATHTUB REFRIGERATION UNIT�–F:.h.EA <br /> LAV�TOFV(WASH BASIN BOILERS–H.P.EA ' <br /> _ ' SHOWER GAS FIRED AC.UNItS–TONNAOE EA <br /> KITCHEN SINKd�ISP. FORCED AIR SVSTEMS–B.T.U. M EA <br /> 019HWASHER WnLL HEniEH3–B.T.U. M <br /> LAUNDRY iRAV UNIT HEATERS–B.T.U. M <br /> CLOtHF.S WP9HER EVAPOMTIVE COOLERS <br /> W�TER HEATER CIOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKIN6 FOUNTAIN qANGE HO00 <br /> FLOOR DRAIN AIR HANDLING UNIT– QEM. <br /> VALUUM BREAKEFS SiOVE <br /> NOOF DMINS–R�INLEADEflS METAL F'�REPUC 8 CHIN.NEv <br /> SINK SEHVICE–BAP ETC. WOODSTOYE/fIREPLACE INSEAT ' <br /> BUBTOTAL SUd TOTAL S <br /> PERMIT i PERMIT ! <br /> __ TOTALFEE � TOTALFEE t _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iROHISfiN�CN qE�RSETB�CK y� SIOESETB�CK �� PL�C�C�(�UM��' FEE��Lp" RECEIPiNO �]/�G-�l •' <br /> / <br />. USE20NE LOT�RE �1��l.j'�) ,,�{} I ((�'`� <br /> R� � S V' 4 ES T'T� FEEB V11LU�TION FFE <br /> ttPEOF�'/lSi. OCCUP�N.pLYGROUP NO.OFOW�AEll�IN0UN113 <br /> i�_� /��� V <br /> SILE OF B100. NOAf BTORIE9 M�k OCG LDAD BUILDIN6 S Z �•._ S — <br /> �G� I IZ� PLUMBINO . <br /> MECHANICAL <br /> FIRE SPRINKlERS(iEOU�RED ❑YES NO <br /> OTHER <br /> PENALTV <br /> •FPUCALION�CC.BY PUNS LNEGK[D BY �PPR.FOR ISSU�NCE 0Y <br />� ^ TOTAL <br /> � L .c , <br /> ��� �r M�� . <br /> � PLr�4 ��f�s ,��5� <br />