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n. Rii�"�' � i.'':•`1't"y <br /> ; � x u •, <br /> °�� ��_�'�` ` 4r ''�`"PPLICATION FO�i:--"' <br /> :,,_.t�;;,.. ,�. <br /> CONSTRUCTIOIN `""`" <br /> �il Y @ <br /> everett PERMIT E+ <br /> BUILDING DEPAR7MENT <br /> 259-87a5 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITfON ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �{SIGN <br /> OW�NnER �/ M�ILqCD(iE55 GIIY IIP pMONC <br /> f�C // �/��L��h,C�.CJ�!✓S ����n /Li//l''�C �l�i=. �Lt� *��N/'�1� %orn$� ?SS-7�R3 <br /> �RCNITECTORUESIGNEN MRIL�DOfiE55 GIlY ilP PMONE <br /> GENEH�LCONTH�GTOR M�ILqDORE55 Cltt Zlp PMONE LICENSE• <br /> —�Ft-.P.t� �`�c�_ fJ�v. Nr1/ 9ir� is/s� ,�'rr. �r/� . ;rF�,�,�iv �ns� e�-ozo/ s'!/P6PE�I/�/7/Nf <br /> MELH�NICALCONTMCTOq M�IL�pORE55 C17Y ZIP PIiONE LICENSE• <br /> PWMBINGCONTMGTOR MMLqpORESS CIfV 21P PMONE LICENSE• <br /> CLA55OF WOflN <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ UEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> W L WTION OF WORN�WST OF M�TEHI�LS PLUS U601ry <br /> ,�` /�SG. °� <br /> OEcCFIBE WOHN <br /> � � <br /> i�/E SG? ,5'ir //1U.c//NN9✓� iri��Cc it/OG'N7E-/� C��76/-� <br /> US FBWLDING ' - <br /> 1 HEqEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ieo �o HIPiIONOFPqOPERTY�SHOWNBELOWORATTACMFOUHCOPIES� PROVISIONSOFLAWSANDORDINANCESG9VERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HERE- <br /> �or_a�oc�_oF - IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O�' <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOIJ <br /> ' OR THE PERFORMANCE OF CONSTRUCTION. � <br /> SIGNATUflE OF CONTqACTOR OR AUTHOFRED AGENT DATE <br /> X _ i <br /> `�_ ,� �,_� ./ ;3-i�-� <br /> FBOlEGT�ODRESS aPPLICANTSCItYBU51NE554LEN5EN0. / <br /> f r� �,.�� y <br /> PLUMBINO MECHANICAL <br /> MO. TYPE OF FIl(TURE FEE NO. T!]E OF EUUIPMENT FEE <br /> WATER CLOSET(TOILEn AIR COND. UNITS-H.P.E0. <br /> BATHTUB � REFRIGERATIOIJ UNITS-H.P.EA. <br /> � LAVATORY�WASH BASIN BOILERS-H.P.EA. <br /> SHOWEfl GAS FIREO AC.UNITS-TONNAGE EA <br /> KITCHEN SINH 8 DISP. FOHCED AIR SYSTEMS-B.T.U. M EA <br /> OISHWASHER WALIHEATERS-B.T.U. M <br /> LAUNORV TRAV UNIT HEA7ERS-B.T.U. M <br /> CLOTHES WASHER EVAPORA7IVE COOLERS <br /> WATEF HEATER CLO7HES Dt7YER5 <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTA�N P.FNGE HO00 <br /> PLOOR DRAIN � A�R HANDUNG UNIT- QF.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF�MIN$--RAIYLF.ADERS METAL FIREPLACE 6 CHIMNEY <br /> _ SINK SERVICE-BAR ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUB TOTAL <br /> s <br /> PEqM1T S PEIIMIT S <br /> __ TOTAL FEE E TOTAL FEE f <br /> THIS PCi�TION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FROHiSETBACN RERRSEIBACN SIDESETB�CK PLANGNECKNUMBEii P�ANCHECNFEE <br /> FEE PECEIPiNO. <br /> GSE20NE � LOT�REA <br /> � - VAC�NTSITE FEES VILLU�TION FEE <br /> OYES ONO <br /> TYPEOFCONST. OCCUFANGYGHOUP NO.OFDWELLINOUNILS <br /> BUILOING � 5 <br /> SIZE OF BIDO NO.OF STOHIES MF1C OCG.LO�D <br /> PLUMBING <br /> MEGHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ VES O NO <br /> OTHER <br /> PENRLTY <br /> APPLIC�TIONACG.OV P�ANSGHECKEDBV APPR.FORISS�E <br /> � \ , <br /> TOTAL <br /> 3'��� <br />