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,�,E�.ro,,,� A�LICATION FOR '�'' ���,�„ <br /> ��n�F CONS7RUCT1.7N e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE CONlPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING '�M.:CHANICAL ❑ PLUMBING O SIGN <br /> � OWNER M�ILA�OqE59 CIfV 2iP P��ONC <br /> '�0�//fN/ /�ES'T � /m/zl r=V�=� bRFCAI Ih�HI/ �UElP7T �Sj�-`//y/ <br /> •RCMII GIOROESIONEH MAIL�DOPESS �..IfY ZIP PHONE <br /> GEN5MLLONIR�CtON MRIL�OUPE55 CII` ZIP PIIONE IiCENSE• <br /> /�J�{8����5, <br /> �i�lT1J�l�' t SL/1�//>SNEE7MEhl L S/3 N 3� SEffT7L F 9�/U 3 �33 S3.3v Zqo c � <br /> MECN�NIC�L CONIR�CTOq M�iL AUDRE54 G�N ZIP VIION[ 4CENSE• <br /> �LtIMBiNGGONIR�CfOR M�4RO�BE55 C�TV 21P P�IONE UCENS[• <br /> CUSS OF WORN <br /> ❑ NEW ❑ ADU1710N ❑ ALTERATION ❑ REPAIF ❑ DEMOLITION ❑ WOOOSTOVF/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LO�IiONO�WOFNILO5f01'M�IE111�15�1C L�OORI <br /> CC.u�� o �/� HvvD a� M.� fT_E �Gf� ��/� <br /> pESLHIBE N'ORN <br /> use o�euaoie�c I HEREBY CERTIFY THAT I HAVE READ APlD EXAMINED TIiIS AP• <br /> p t,(ctA� PLICATIONANDKNOWTHESAMETOBETRUEANDCORREC7'.ALL <br /> LEO�L�ESL�IPIIONOFPROPEIIfY14110WN0ELOWOf1AtTAC11F0UPCOPIf51 pROVI510NSOFLAWSANDOR0INANCESGOVERNINGTHISTVPE <br /> Or WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or—o�ocic._ov IN OF NUT.THE GRANTING OF A PERMI��DOES NOT PRESUME TO <br /> GIVE AUTl10RITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONiRACTOR OR Al1THORIZED PGENi UnT[ <br /> � �Il d'� y- � -aa -� X�`�.�'l� �%�.::_.�. __ z /.� <br /> PPOJECf�DOf1F55 RPPLIGONTSCITYOUSINE55 LICENSE NO <br /> �0/,�I �✓P/�P�1 ' .� - <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF'rl%7URE FEE NO. TYPE OF EOIIIPMENT FEE <br /> WATERCLOSET�TOILEn AIRCGND.UNITS—H.P.EA. _ <br /> EiATNiUB REFRIGERATION UNITS—H.P.EA. __ _ <br /> LAVATOFY�WASH BASIN� UOILERS—H.P.EA. <br /> SHOWER GAS FIRED AC.UNITS-70NI�AGE E0. __ <br /> HITCHEN$INK 8 DISP. FORCED AIR SYSI EMS—B.T.U. M EA. _ <br /> DISNWASNER WALLMEATERS—B.T.U. M _ <br /> LAUNDRY TPAV UNIi fiEATEflS—B.T.U. M _ <br /> CLOTHES WASNER I EVAPORATIVE CUOLERS � j_U <br /> WAfER HEATER CLOTHES DRYERS <br /> U�71NAL I VENTILATION FAN CF JL� <br /> DRINKING FOUNTAIN RANGE HOOD _ <br /> FLOOR DRA�N AIR HANOLING UNIT— C.F.M. ___ <br /> VACUUM BREANEHS SiOVE — <br /> ROOF(`RPINS—RAINLEAOERS METAI FIREPLACE 8 CIiIM11NEV _ <br /> SINK�SERVICE—BAF.ETC. WOODSTOVE/FIPEPLACEINSEFT " _ <br /> 5UBTOTAL SUBTOTAL S �j� <br /> PEHMIT S PERMIT S / _ UU <br /> TOTALFEE S TOTALFEE S � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iNONiSEIBRLK AEMSEIBACK SIDESETBRCK PLANCREG NUMBER PUNCN[CNPEE <br /> G-� ' / � iEE PECEIPf NO <br /> USE20NE LOTAPER VACANTSItE O O� <br /> FEES V�LU11t10N FEE <br /> GYES pN0 <br /> TYPEOFCONST. OCCUPRNCVGHOUP �NO.OFDWELLINOUNII$ <br /> BUILDINa 5 <br /> , SIIE OF BLD�. NO.Of SIOPIES MA%.00G LORD <br /> PLUMBING <br /> MECHANiCAL � <br /> FIRE SPRINKLEFiS REOUIRED ❑ YES O NO <br /> OTHER <br /> PENFLIY <br /> AYPlICR110N�CC flY f'LANSC�IECKE08Y r1PFR�Ofil$SU�NGEBY -- <br /> TOTAL <br /> ��. �1� <br /> , ,. ;.: ..:. : , . <br />