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�:PPLICQ►TION FO;�� ��t,�„ <br /> '".E"ro'""� CONSTRUCTION � <br /> �,r oF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE C�JMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING O 1AECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNER M��I�DOPE55 Cltt ZIP PN011E <br /> //'����.6��'� 73� rl��:.�G G-yr-�-% �� ��.�oo�� <br /> , <br /> ♦ppU�ECIORpES�GNER M�IL��OP[SS pr 21P 10NE <br /> GENEHa:CONiR�LtOR MML�ODAE59 C17Y 21P PNONE LICENSE• <br /> MECN�NIL�LLO4iR�C- TOfl__ -- MAIIADDRl59 C�1Y 21P PHONE LICENS[• <br /> PLUY81N0LONiP�CtOC MML��DRE55 GIfY IiP FIIONE UCENSE� <br /> "_ _"__'_.—�� <br /> ""__"_�-�'__ <br /> CL�550!WOAN <br /> ❑ NEW ❑ ADDIT�ON ❑ AL7ERATION ❑ REPAIH DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCATION <br /> VALU�TIDN Of WOAK IG041 O(MAtC���LS PLUS 1�BOAI <br /> OESLRiBE WO�K I /" ��U� LOI . `�/ D/���' <br /> - � T. �Ld .C'��.f��.� <br /> USEOf BUILD�Na I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �y �.�—���l1/L� ^ PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> IEG�lDESCR�P1i0NOFFPOPERLv�SHOWNBELOWOR�TT�GHFOURCOPIESI PROVISIONSOFIAWSANDORDINANCESGOVERNINGTHISTYPE <br /> 'J• /1� 'G YG�jT OFWORKWILLBECOMPLETEDWITHWNETHERSPEC�FIEDHERE• <br /> �or�e�oc�.Lo IN OR NOT.THE GRANTING OF A PERMI'DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> c�-;a�r��� �9�o ZB.`�ui�t r� �� ' OR THE PERFORMANCE OF CO STRUCTIONNG CONSTRUCTION <br /> n� /����f'�iL /��� /f/� �T � SIONANREOFCONTRACTORORAUTHORIZEDAGENf DATE <br /> (G�. ivH��.,r! (A7 Ly'— <br /> x '3f� <br /> s <br /> PFOJCCi�DURESS �PPIIC�Nt IiYBU51N LICENSEN <br /> 9Z/z C'a'�� <br /> PLUMBINO MECHANICIIL __ <br /> N0. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WqT6R CLOSE7(TOILET) AIR CONO. UNITS—H.P.EA. <br /> 9ATN7U8 REFRIGERATION UNITS—H.P.EA. <br /> �PVATORY(WASH BAS�N� BOILEHS—N.P.EA _ <br /> SHOWER OAS FIRED AC.UNITS—TONNAGE EA. <br /> NITCNEN SINK6 DISP FORCEDlJR SVSTEMS—B.T.LL M EA. <br /> OISHWASHEF WALIHEATEFS—B.T.U. M <br /> L�UNORY!B�V UNITNEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> W�TER HEAiEH CIOTHES DRVERS _ <br /> URINRL VENiI1ATION FAN i <br /> DRINNINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. _ <br /> VACUUM BREAKEf1S STOVE — <br /> ROOF ONAINS—RAINLEADERS METAL FIREPIACE 8 CHIMNEV <br /> SINN�SERVICE—BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUBTOTAI 3 <br /> PERMIT 3 PENMIT : <br /> TOTALFEE 3 TOTRLFEE 3 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fNpNiSEipRGrc AE�RSEiB�GN SIDESETB�CK PUNGHEGKNUMBER PLANCHECKiEE <br /> fEE nEGEIPiNO <br /> USE 20NE LOf FFEA y�C�NT SITE FEEg V�LURTION FEE <br /> OYES ONO <br /> TYPEOfCONSi. OCCUPANCYGROUP NO.OFUWElLINOUNli9 <br /> BUIlDINO f <br /> 512[OF BLOO NO 04'SIOnIES Ml1%OCC.LO�O <br /> PLUMBINO <br /> MECHANICAI <br /> FIRE SPRINNlERS AEOUIR[D ❑ YES O NO � v <br /> OTHER <br /> PEtl�LTY <br /> �PPIiC�OONACC tlY �LANSCMECKEOBY APPF.FORISSWNCEBY <br /> T0TI1L <br /> —�� <br />