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. .PPLICATION FO►. <br /> u E�°'"° CONSTRUCTIOR ""`" <br /> everett PERMIT � <br /> BUILDING DEPARTMENT <br /> �59•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING j+.9;SIGN <br /> OWNEq M�ILADORE53 CITY IIP PHONE <br /> �C�EL4� •���'.��2.� On9�Yv7S .53a`i �✓cyz�zee�� c.,✓�-Y �v'�' <br /> APGNIIECTOROESIONER MAILAODFE53 CITY ZIP PHONE <br /> OENEH�IGONTq�pTOq M�IL�O�qE55 CIIY ZIP PHONE uGENSE• <br /> ,C'c�n.nY iv�o,v <'o .�VC 2/027 C�IS� �.1, GYi'✓^' /�64 �C�e� 77E S£sJS �,b�!/!Y/J24`7�i, <br /> MECHINICALCONLR�GTOq M�IIADORE55 CITY ZIP PHONE VCENSE• <br /> PLUMBINOGONiPACTON MAIL��OHEF. CpY ZIP PIIONE IICCNSE• <br /> CUSS OF WORk <br /> �. NEW ❑ A�DITION ❑ ALTERATIQN ❑ REPAIR ❑ DEMOLI710N ❑ WOODST VE/FRPL.INSER7 ❑ BUILDING FEIOCATION <br /> V�LU�TI NOFW�pN�COSTOFM�iERIALSPUSLA901:i ,U i O � <br /> �, � O� <br /> 71�"72 J: 7r/57?3ZL i9-T_Z t3r�/ O'l1�L Y � '- JJ 1-!l,Y I�� -TU�Y.c.t� G O 5 T _, <br /> o� IBE WORN � JGG / / �IUA! �L U> I t e,�T•y LL �0 7'!61V o <br /> .77�ST7�t� C/ ) 3 X� S' �v �21�rL (,lic� S2�e5'N �'.L_/3u'h�rlH/tf2�Ftif <br /> USE OF 901LDIN6 � ' <br /> �mM��� Sr,�v I HEREBY CeRTIFY THAT I HAVE READ AND EXAMINED TH!S AP- <br /> PLICATIO'V AND KNOW THE SAINE TO BE TRUE AND CORRECT.ALL <br /> IEO�L0E5CRIPiIDNOFPROPEN1YI5tipWNBEIOWORIIi�LHFOUNCOPIES} pROVI510NS�FLAWSAND�RDINANCESGOVEFNINGTHISTYPE <br /> OF WORK WILL BE COMPIETED WITH WHETHERSPECIFIEC HERE• <br /> LOi_BLOCIL_OF IN OR NOT.THE GRA.NTING OFA PERMIT DOES N0T PRESUME TO <br /> GIVE AUTHORIiY 7�J VIOLIITE OR CANCEL THE PROVIiIONS OF' <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCT:ON <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATUflE OF CONTRACTOR OR AUTHORIZEO AGENT OATE <br /> X S� 5��� <br /> . <br /> PFOJECT�D�RESS �PPLIdNi IiYBU51NE5SLICEN5EN0. <br /> sa o s L�v�rz 6rze-t�iv o--�}-S- <br /> PLUMBINO MECHqNICAL <br /> NO. TYPE OF FIXTUHE FEE N0. TYPF.OF EOU!PMENT FEE <br /> WATER CLOSET�TOILEn AIR CONO.UNITS—fi.P.Eh. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA. <br /> UVATORV�WASN dA51N� BOILERS—H.P.EA. <br /> SHOWEH GAS FIRED AC.UNITS—TONNAGE E0. <br /> KITCHEN SINK6 OISP. FORCEO AIR SYSiEMS—B.7.U. M EA. <br /> DISHWASHER WALL HEATERS—B.T.U. M <br /> LAUNDRVTHAY UNITHEA7EFS—P.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES�RYEHS <br /> UFINAL VENTILATION FAN <br /> DPINKINO FOUNTAIN RANGE HOOD _ <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DMIN�RpINLEADER5 METAL FIREPLACE 8 CHIMNEV <br /> SINK SERVICE—BAR,ETC. WOODSTOVE/FIREPLACE INSERT _ <br /> SUBTOTAL SUBTOTAL S <br /> PERMIT S PEHMIT S <br /> TOTALFEE S TO7ALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONf5ET8ACN PE�NSETBACK SIOESE7B�CK PLRNCMECKNUMBEB PUNGNECNiEE <br /> FEE RECEIPI N0. <br /> USE2UNE IOIAREA VACANTSIiE <br /> FEES ��1U11ilON FEE <br /> OYES ONO <br /> iYPEOf[ONST. OCCUPRNCYGROUP NO.OFUWELIIN(iUNI?5 <br /> BUILDING f �L <br /> SRE OF BL00. NO.OF SIORiE9 MAK OCG LOAO <br /> PLUI.IBING <br /> MECNANICFL <br /> FIRE SPRINKLERS REOUIRED ❑YES O NO <br /> OTHER <br /> PENALTV <br /> �PPLICAlION AGC.BY PLANS CHECNEU BY �PPR.FOP ISSU�6N��p/gv� - <br /> «-�/ TOTIIL <br /> _ �� �� <br />