Laserfiche WebLink
,�.F~,°n.� ���CO N STR U�CTI O N <br /> C0Y OF <br /> ���,�n <br /> everett PERM�� � <br /> TO BE COMPLETED IN BLACK�t:K— PLEP.SE PRINT <br /> BUILDING DEF?. <br /> 259-8745 ❑ GOM9INATION ❑ RUI401NG ❑ MECHANICAL ❑ PLUM�BIN(3 lld SI6N <br /> OWNEfl M�IL.1DOqE34 GiTY 21P PNONE <br /> f�"i�i.iNSi(���'ri>r S' %U/•� 1 ���L-�iZlGy2r_"�-h.1 nt _ r � <br /> �e G—i�t.n.�r s=.-/ J�1'�:- <br /> �RCMIIECTOROElIONEN MAIL�UDRE99 ` • � CIrY ZIP PMONE <br /> pENERAI.CONOUCf08 MAILADDRE99 CIiV 21P PIIONE LICENSE� <br /> �C'�;11uL� ,�1-�z% i//fi ..� JT SZ AUr� c�.L � fi�,:� �'—S�� �3•�,;•: �% <br /> MECIUNICAICONTMCTOq M�IL�OOFESS GIIY 21P p110NE �If�[�jSE� <br /> L���..,: ��;;,�.r,c+ <br /> PLUMOS�O[ONi�ACTON MAiL�OJHESS IY Zip ' pI10NE UCEIISE• <br /> GL�SS OF WORN —' _ <br /> CL�I/NEW ❑ ADDITION U ALTERATION ❑ PEPl,IR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINQ RELOCATION <br /> V�LU�110N OF W011K�CC51 OF M/UE'+'•:l5 f'LUS LABOH� —�- <br /> � �) ��(J - <br /> DESCAIBE WOHN — <br /> � f <br /> �. ,- ,-�.,L _ � „ r l Si.v�ic- � �:4 �do.. , . � ,E- - <br /> use ov auaoiHu <br /> I HEREBY CERTIFY THAT I HAVE REA�AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG�LOESLflIPbOHOfPqOvERIY�5110WNBELOWOPATIACNFOL'RCOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNMCiTHISTYPE <br /> WT�BLOCI�.OF OF WC��K WILL BE COMPL'eTED WITH WHETHER SPECIFIED IIERE <br /> IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THL" PROVISIONS O� <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTqUCTION. <br /> SIGIIATURE OFCONiRACTOB OR AUiHOH12ED AGENT DATE <br /> )f.).� !'1 i t?. 7 ' ^���✓( ���.�/� <br /> PqOJECfA00BE55 APPLIC TSGIIYDUSINESSLICENSENO. � <br /> l ����� �:"4/cl�Lw'.cC�.J �C.����� .Sc.i! /< /Cl �> /f�a. <br /> PLUTABIN6 MECHANICAL <br /> N�• TYPE OF FIXTURE _ FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILEn AIR COND. UNITS-H.P.EA. <br /> BATHTUB REfRIGERATION UNITS-fi.P.EA <br /> LAVATORY�WASH BASINI 901LER5-H.P.EA. <br /> SHOWER GAS FIRED AC.UNITS-TONNAGE EA <br /> KITCHEN SINK 8 UISP. FORCED AIR SYSiEMS-B.T.U. fA EA <br /> OISHWqSHER WALI.HEATERS-B.T.II. M <br /> LAUNDRYTflAY UNITIIEA7ERS-B.T.0 M <br /> CIOiHES WASHER EVAPURATIVECOOLERS <br /> WATER HEATER CLOTHES Dq�ERS <br /> U111NAL VENTILATION FAN <br /> DflINKING FOUNTAiN RANGE HOOD <br /> FLOOR ORAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> HOOF DRAINS-RAINLEADERS METAI FIREPLACE 8 CHIh1NEV <br /> SINK SERVlCE-BAR,ETC. WOOOSTOVE/FIREPLACE INSERT <br /> SUBTOTAL _ SUBTOTAL S <br /> PERMIT 3 PEHM17 S <br /> __ TO7AL FEE S TOTAL FEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FqUNT5EIB�CN qEAR5EIBACK SIOESETOACN PUNCHECKNUMBEN PUNCHECNfE[ <br /> FEE pECEIVf N0. <br /> USEEONE LOTAPEA VOCRNTSILE <br /> OYES ONO FEES VRLUATION FEE <br /> TTVEOFCOIIST. OCCIIP�NCYGAOUP NO.OFDWELlINOUHlT9 } <br /> BUILDING f <br /> 512E OF BLW. NO.OF SIORIE3 MAK OCG LOAO <br /> PLUMBIN6 <br /> MECMANICAL <br /> FIRE SPRINKLERS FEOUIRED ❑YES ❑NO — <br /> OTHER <br /> t'tNALTY <br /> APPLICI1ilON ACC.BY p�ANS CHECNEO BY APP0.FOR ISSUFLN7C`E pY ' <br /> (/K C� TOTAL <br /> _____—'___"'_'_ __ " _._.... .'___ _'__""" .. ' <br /> � <br /> S�(`��� <br /> �J� <br /> � .�� <br />