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QPPLICA7IC l FOR CONSTRUGT�-1N PERMIT �� <br /> TO 8E COMPLETED IN BLACK INK—PLEASE PRINT �r <br /> ��- <br /> BUILDIhJG DEPARTMENT f HEATING SVSTEM: J GAS J ELECTRIC J <br /> 259-8870 --— ----_ <br /> XDEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> "n tMiLApDRESS � <br /> UiY " Prq';. — <br /> A� S��n-l.. �q �� ��. y ��2�� "�1! �j L��-/� ' '"'e � Z� <br /> EI N M�ILADDRESS � <br /> cirv Z�a PHDNE -_ <br /> nRC�eiEQORDESIGNER MAILAODRE55 CiiY - <br /> �kV� /'y n,,..� � ZiP PNON: - - <br /> V.7V1.7\/ "L9 I o Coc.t�f C�.�u.."�1' U.�fa, 9 Y�"Z..a Z�1-4�3 y 4- <br /> �J•JrqAIGONTqAC70R URILADDRESS CITY ZIP -- <br /> _ /',i_ ,v� n� / P���E ST4TE UCENSE Y <br /> - lJLA.LLL4�L� <br /> .� ��� GF1CONiqFCTOR MA4A�DNE55 p�Ty � <br /> Z�P P�E STATE LICCNSE� <br /> . ."�'.RIG"ONTRALTOR 1Ap�LRODRE55 CITV 21P <br /> P��E� STATEUGENSE� <br /> �.�-':��iACTPRICEOFW K <br /> � '20�ObC� <br /> .`�.:.RiFEWOReAN�50UAREF(�tpG[IHOIVED / CONiACIPERSONAN�pHONENO <br /> _ - L�5 - �Y1.. O _ V __ <br /> ��.)``i-1�A1. A1CV.� 5j'b1LC- T-itD1.T`"�� <br /> 1+3-sr'a _ G , �. <br /> PAoroseouseovoun.r.�Ne i HEREBV CERTtFV THAT I HAVE qEAD AND EXAMINED THiS <br /> _ � APPLICA710N AND KNOW THE SAIdE TO 0E TAUE AND COFRECT ALL <br /> PROVISIONS OF LAIh'S AND ORDINANCES G')VERNING THIS TYPE CF <br /> i[Ga�DEscmm�o!aoFvr�o�iatyi�Sv-oywwBEtrnYORAnACnrvuoCoaiE51 WORK WILL BE COMPIETED WITH WHETHER iPEGFlED HEREIN OR <br /> �or��.Z uwc% ��1_ or �T �� ���.-YI- NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GN[ <br /> AU7HORITY TO ViOLATE OR CANCEL THE PA.�VISIONS OF P.NV <br /> . OTHEF STATE OR LCCAL LAW REGULATING CONSTti;ICTION OR TRE <br /> PERFOR�IANCE OF CONSTRUCTION. 7HAT I AM AUTHOPIZED BY T�iE <br /> _ OWNER OF THIS PR `EHFX TO PERFORM TH[ 1M1'OR✓ fpR IVHiGH <br /> �RRCELTAxI� NlIMBER APPLICATION IdAI�E gt�p I COMPLY VJ�'H ii-{E S?Ai C <br /> CONTRACT LAW-1� Yf�LWti;ND 296.200 WAr <br /> � :��+l:CiiGHIOANLI��DER ADDRESS.TEL[PHONENUMOER�� / <br /> PROJECT A40HES5 �-^�� �z���"�-- _ I U�I I.�_��i_ <br /> Z o) ��ZBo''i Co�f3y AA�e _< ,_" — �,,.,� - <br /> , , ,_ . �.. , . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUiPMENT <br /> WATER CLOSET�TOILETI FEE <br /> — ' ��C-A'HNDLGUNITS-N.P. � <br /> BATHTUB FORC[G AIR SYSTEMS-B,T.U. M E.A --� <br /> LAVATORV(WASH BASINI UNIT HEATERS-B.LU. M � <br /> SHOWER CLOTHES DFYEFS <br /> KITCHEN SINK 8 DISP VENTILATION PAN <br /> DI�HWASHER � RANGE HOOD —T—" <br /> .AUNDRY TRAY ' WATER H[ATER <br /> CLOTHES WASHER WOnD STOVE <br /> URINAL ; METAL fIREPIACE(WOOD BURNINGj <br /> DRIIvKING FOUNTAIN i FIREPLACE INSERT i -- <br /> FLOOR DRAIN HEAT PUMP �- <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> _ SINK�SERVICE-OAR,ETC.) <br /> — --T-- <br /> T <br /> . SUB TOTAL 8 SUB TOTAL $ <br /> -_ PERMIT $ PERMiT $ ' <br /> TOTAL FEE $ TOTALFEE � - � <br /> FOR OFFICE USE ONLY: - <br /> ���OfJTSfi3ACK F[AqcET9FCk SiDE5F1AACK PI.ANCNECKNUMBEB f[C- RC.CE6iN0 <br /> �/ l5" .SS Z �/ <br /> �-'���%���+� �or nAen vacaNT sire FEES VALUATION FEE <br /> _ �?"� ;--� VES ,f.l NO — <br /> DUILDING n^��ry7� 7 7 � <br /> tr�Y u�C�Il51 NO.OF STORIES cuu�enpv r;o o�evxuwpure*^ L!! S/ 6 G <br /> � � cao' p�UM81NG � �, � <br /> '.�.iZ[OF6L�G. FIRESPRINKlER5RE0D BASEMENT - <br /> �Z.�D G� �lJ(J I ' YES �C NO MECHANICAL � <br /> ��:curnrvcvLOAo Finen�n1nan�ne0�o r+eic��rin.nrnnor� ADDITIONALPLANCHEGK � <br /> --j3� 'Vd OTHER � <br /> �. ..::� <br /> . STATE BUILDING SURGHAfiGE � �5 <br /> �•'.':���' �... � i�tnr:5nrnncvEoc� — <br /> CI7Y OF EVERETT PUALIC YlORKS <br /> �M LOCAL SALES � <br /> ���-� �p � � TA�(CODE IS 3105 rorn� ��� ��—, <br />