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�. 1 <br /> tMEnrprN^ APPLICATION F(��R ���,�„ <br /> ��noF CONSTRUCTION e <br /> everett � PERMIT <br /> TO BE CpMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> pp/pEp MAILAOOfiE55 C17Y ZIP FMONE <br /> AnGNI1ECtOPDE5IGNER MAlLA0DRE55 QiY ZIP PHON[ <br /> S�[�r.�G M <br /> ri� von, o U ,(�iru.h.vdi» o��s'ss �4��es.0 y�a� Kc BLv 900>l L�L.�3 92 /c� <br /> OENE LCONtRACTON MAIL�OOPE55 CIIY ZIP PNJNE LICENSE• <br /> ' MECNIINICAI.CONiNRCiOq MRILp00NE55 CIiY 21P P��ONE LICENSE• <br /> PIUMBINOCONfP�CIOR M��LAOONESS CITY 21P PHONE UCENSE� <br /> C1A550F WORN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVEIFRPL.INSERT ❑ BUILDING RELOCA�ION <br /> V�W�ll OF W ORK I W ST OF MRI ERIAL9 PLUS LABOP� <br /> ��n� �� <br /> OESCRIBE WORK - <br /> S�� �c s <br /> use ov euuoir+a <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TOOETRUEANDCORRECT.ALI. <br /> LEOAL�ESCHIPiIONOFPROPENtY�SNOWNBELOWORAIIACHFOUHCOPI[51 PROV�SIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �or_eioc�or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OA CANCEL THE PROVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUPE OF CONTflACTOR(�R PUTHORIZEU�GEOT DATE <br /> X �,�y,v p�k -�! c-� - <br /> �L < <br /> - � � -�.r� CtJ �CGG�-� � ��? � <br /> PPOJECT p00NE59 APPLIC�NTS CIiY BlI51NC5S LIGENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUflE FEE NO. TVPE OF EOUIPMENT FEE _ <br /> WAiEP CLOSET�TOILE7) AIR COND.UNITS—H.P.EA. _ <br /> BATHTUB REFfiIGERATION UNITS—H.P.EA. <br /> LAVATORY�WASH BASIN) BOILERS—H.P.E0. _ <br /> SHO�'+EP GAS FIRED AC.UNITS—TONNAGE EA <br /> KITCHEN SINKB DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER ' WALL HEATERS—B.T.U. M <br /> LAUNDHYTRAY UNIiHEATERS—O.7.U. A1 <br /> CLOTHES WASHER EVAPOPAiIVECOOLERS _ <br /> WATER HEATER CLOTH[5 DRYERS <br /> URINAL VEN7ILATION FAN <br /> DRINKING FOl1NTAIN RANGE HO00 <br /> FLOOR ORAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKEFS STOVE <br /> f700F DRAINS—RAINLEADERS METAL FIREPLACE 8 GHIMNEY _ <br /> SINK SERVICE—BAR,EiC. 'NOODSTOVE/FIPEPLACEINSERi <br /> SUBTOTAL SUBTOTAL S _ <br /> PEflMIT S PERMIT S _ <br /> TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> F NfSEiB�LN �GOSEI9RCK SIDESETBnCN A Plr1NCHEG NIIM6CR FF.E ��hNCNECNFEE <br /> / ^� /���� /! � �ECEI�t N . � <br /> 0 (� <br /> USE2JNE LOIAfI� NTSITE ypLUATIDN FEE <br /> FE=3 <br /> .'IYES ONO -- <br /> TVFEOFCONST. OC P GROUP NO.OF�WE�:�.',7UNIT9 <br /> � BUILOINO 5 � 004 � -� 0 5V <br /> SILE OF Bl0 NO.OF SIOBIES , MA .LO�O <br /> PLl1M�ING <br /> MECHANICAL <br /> FIPE SPRINKLERS RE�UIRED O YES NO <br /> OTNEfl <br /> PENALTY <br /> ' pPPLICRT�ON pGC.BY PLANS LIIFCRED OV RPPR.FOfl ISSUANCE 0Y <br /> ' TorA� ,;l�0 54 <br /> J��: <br />