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fMEwrpn�n �PPLICATION FO� <br /> everett CONPERMITTION °"``'�`" <br /> BUILDING DEPT. TO BE COMPLETED IN BLACK INK— PLEASE PRINi <br /> 259•8745 ❑ COMBINATION L� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER /�,� // MAILADDRESS 1 L CITY / q 21P PHONE .//� <br /> APCMITECTJ�i.C��LL T���AD��J�bG/ 7D1��.���3 i/d ILl /`���jl ( !�/G� A?'/ �`-!'� <br /> Cltt 21P �� PHONE <br /> OENEML CaNTRACT MAIL pDDRESS /�CITV � <br /> �y r Z�P PMONE LICENSE t <br /> MECHANICALCONTMCTOfl MALAOOqEGS u <br /> CITY ZIV PHONE UCENSE• <br /> PLOMBIN�CONTR�CTOP M�ILAUDRESS l� ��n. <br /> Z�P PHONE LICENSE• <br /> cus woaK <br /> r s <br /> v���E OFwOK�5�7o'O ATERIOpLSPL S A801�N � REPAIR ❑ DEMOLITION ❑ WpODSTOVE/FRPL.INSERT ❑ BUILDING FELOCATION <br /> 7 �82.7�0'� <br /> DESCHIBE WO� , <br /> I � <br /> USE OF BUILDINO <br /> ' � • � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> LEGRLDEBCRIVTION FPpOPENTY�3HOW BELOWORATTACHFOURCO IES� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> OFWORK�WIL�L ECOMPLE EDDWITHWHET ERS ECFIEDH RE• <br /> �or�e�oc�or��� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> eG ' y 61VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> � OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONT TOR OR AUTNOHIZED AGENT OqTE <br /> PRQI GTAD qE � O � � � <br /> ICANTS TV USINESS LICENSE N0. <br /> �/Ua ✓�P/I(�1. Gt� <br /> PLUMBINO MECHAN AL <br /> NO. TYPE OF FIX7UqE FEE NO. TYPE OF EOUIVMENT <br /> WATER CLOSET(TOILE7) FEE <br /> AIR COND.UNITS—H.P.EA <br /> BATHTUB REFRIGERATION UNITS—H.P.EA. <br /> �AVATORY WASH BASIN BOILERS—H.P.EA <br /> � 9HOWER GAS FIRED AC.UNI7S—TONNAGE E0. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALLHEA7ERS—B.T.U. M <br /> LAUNDRYTRAV UNITHEA7ERS—B.7.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLO7HES DRVERS <br /> URINAL VEN71LA710N FAN <br /> DaINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIF HANOLING UNIT— C.F.M. <br /> VACUUM BqEqKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAI FIAEPLACE 8 CHIMNEV <br /> SINK SERVICE—BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> 8UB TOTAL SUB TOTAL s <br /> PENMIT S PERMI7 s <br /> TOTAL FEE f TOTALFEE s � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSO�NEL <br /> �S9. i <br /> FRONTSETBFCN / REAflSETBACK SIpESETBAGK PLANGHECKNUMBER PLANCNECKFEE <br /> r ' <br /> �� �/_� FEE lJ'O RECEIPT 110oo k <br /> USE ZONE ��T pREA y�CRNT SITE (`/ � 1 ` " <br /> C,"'� ' 7`j� �ES ONO FEES V1ILUATION FEE <br /> TYPEOFCONST. OCCUPAN YGROIIP NO.OFUWEILINGUNITS <br /> SIZE OF� NO.OF STORIES MAX.OCC.LOAD BUILDING §• O/ . / � <br /> Zq y <br /> � IO � � 3� PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKIERS RE�UIRED ❑ VES NO <br /> OTMER �� //' <br /> /.t �iJJ <br /> PS������ �/� <br /> APPLICATION ACC.BV P14N5 CHECKED BY APPq.FOR ISSU�NCE BY � J� <br /> TOTAL <br /> b l� <br /> �M �� 3 <br />