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�,-'PPLICATION FO`►:� ���,�„ <br /> '".E"'°'"" CONSTRUCTION 0 <br /> GtY Oi <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ CORABINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNEH MRILA�DRE59 GItY 21P PHONE <br /> //A �ii TRi=NnS 440" s /��i=rt6x -fN wNY �=vsR�=ir 2rp-!9l/ <br /> ARCNrtECTOR0E5�ONEP MAIL��OHE55 Clrv � IIP VHONE . � � • . . <br /> OENEPALGONTH�CION M1ILAUDHESS Lltt ZIP PNONE LICENSE• <br /> �UAFp1D/t L-LEG. ADY• NW �i//7 /J/sT,yvEA'�� R6D.uoN 9€a�7- kBl��o� SUP6'REf� /H)T.h <br /> M[LM�NICALCONfP�CTOq MML��ORE99 C�N =�P PNOHE IICEN9E• <br /> PLyM81N090NTR1GiOR M�R�OOR[SS � - C�rv �IP PIIONE LICENSE• <br /> CL�380F WORN <br /> � NEW ❑ A�DITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFiPL.INSERT ❑ BUILDING REIOCATION <br /> V11W�TION OF WOFNIWSi Of MniElIIALS VLU9 L�BUNI <br /> ��Opo cx <br /> � OESCRIBE WONN <br /> ; /Nsr tL S - S'!c i w LI <br /> U9E OF BUIlDINO I HEREBY CERTIFY TIiAT I HAVE READ AND EXAMINEC THIS AP• <br /> ! PLICATION AND KNOW THESAMETO BETRUEANDCORREC7.ALL <br /> � LEO�LOESGRIPTIONOFPHOPENiY�5110WNBELOWOR�IT�GNiOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> i OF WORK WILL BE COAIPLETED WITH WHETHEfl SPECIFIED HERE- <br /> j �er—e�oc�—or INORNOT.THEGRANTINGOFAPERMITDOESNO7PRESUMETO <br /> ! GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> 1 ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . ,� ... <br /> I � SIONATUREOFCONTRACTORORAUTHORIZEOAQENT O�TE � ' , <br /> � X � �/� <br /> PPOJECTADOflE35 �PPLIC�NTSCIiYBU51NE55lIGEN5EN0. Z <br /> PLUMBINO MECNANICAL <br /> NO. TVPE OF FIKTUAE PEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEi) qlR CONO.UNITS—H.P.EA <br /> BRTHTUB REFRIGERATION UNITS—H.P.E0. <br /> LAVATORY WASH B�SIN� BOILERS—H.P.EA. <br /> SHOWER OAS FIPED AG UNITS—TONNAGE EA <br /> KITCHEN SINK6 DISP. FORCED AIR SVSTEMS—B.T.U. M E0. <br /> DISHWASHER WALLHEATERS—B.T.U. M � <br /> UUNDRYTRAY UNITHEATERS—B.T.U. M <br /> ' CLOTHES WASHER EVAPORATIVE COOLERS <br /> ,� WATER HEATER ' CLO7HE5 ORYERS <br /> URINAI VENTILATION FAN <br /> � ORINKING FOUNTA�N RANGE HOOD <br /> � FLOOR DRAIN AIR HFNDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—flAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> �0 SINK SERVICE—BAR,ETC. WOODSTOVE/FIREPLA(:E INSERT <br /> � <br /> F � <br /> '� <br /> � <br /> r <br /> i <br /> � SUB TOTAL 9UB TOTAL t <br /> � PENMIT f PERMIT i <br /> TOTALFEE f TOTALFEE t <br /> � THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL � 1 � � <br /> :, <br /> Q iHONlSEfBACK flEAP5Ei6�CN SIDESETB�CK , P��NCNECKNUMBER PL�NCHECNFEE <br /> A FEE AECEIPTNO. <br /> � USE20NE LOI�:IEA y�C�NT51fE <br /> OYES ONO FEE9 VALO�TION F[[ <br /> 5� „ „ , . <br /> �� ttPEOFCONSi. OGLUP�NGYGPOUP NO.OFOWELLINOUNITS <br /> � BUILOIN� 3 . ...... <br /> SIZEOFBiDQ NO.OFS70RIE9 MA%.OGC.lOAD <br /> .,� PLUMBINO <br /> u� <br /> I� MECHRNICAL <br /> ?� PIRE SPRINKLEFS REOUIRED ❑YES ❑ NO . �, i . <br /> y OTHER . . . . <br /> :� 1 ' ' <br /> PENALTY <br /> �� APPIICAIION�CC.BY PL�NS CHECNED BY APPR.FOR ISSl1AN B <br /> � �(,�7 TOT�L <br /> D.I � <br /> � '`'? �- �Z¢'8� <br /> ; <br /> ,, <br /> :., <br /> , <br /> - �- ,� � ..,,,: . . <br />