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"l <br /> �� MrEwNmn .���PPLICATION FO��z everell <br /> ��r�F CONSTRUCTION e <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> DUILDING DEPT. <br /> 259•8745 ❑ COMBtNATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> � OWNEfl MAILADDRESS Cltt ZIP PNONE <br /> ���N�n 5' �inds�= � 5r7oC r��csr ��. LUc�zcrr 98�3 asa - 97a/ <br /> ARCMRECTORDEBIONEN �M�II�DDRE89 CITV 21P PHONE <br /> �ENEMLCONTR�CTON M�ILApORESS CIiY 21P PHONE LICENSE• <br /> 'C'on, �iN�s�„�'o„T y7o( l=c►2.�T�r E�-r-/�=Lr" -r'18�3 �s�-97a/ 9//aa�:3.�, <br /> MECH�NICALCONTR�Oq/� MAllA00RESS CIII ZIP PHONE LIClN!!• <br /> Y <br /> PLUMBINO GONTRRCTOR , M�IL RODRE55 Cltt ZIP PNONE LILENSE� <br /> IV % <br /> L3./ � <br /> Cl�S3OF WOHK <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION = <br /> W�UA710N OF WORK�CA9T OF M�TERI�LS PLUS L�BORI � <br /> � �a8 s • 9 9 _ � <br /> OESCRIBE WORK m <br /> ��Xc�� � ak l�G�/2T <br /> USEOFBUILDINp � � <br /> I HEREBY CERTIFY THAT I HAVE READ AN� EXAMINED THIS AP- "� '� <br /> �i91�lt� LJ/�NS PLICATIONANDKNOWTHESHMETOBETRUEANDCORRECT.ALL �-+ -1 <br /> lEO�LDEBCRIPTIONOFPROPEPTY�SHOWNBELOWORATTACMFOUHCOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE Nm <br /> OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHEFE• o <br /> �or—e�ocK_oF � INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO mo <br /> , .� GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK c� <br /> g !, I2 ✓i !i O 7 o ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION o c <br /> /. y �. <br /> OR THE PERFORMANCE OF CONSTRUCTION. r3i+ <br /> r U� S%O% � E� SIGNATUREOFCONiRACTORORAUi1�ORIZEDAGENT DATE m.-� <br /> �re e ad� ��✓ �/c�u. ir�c �o o�' P/•,�sJ X.0 �Ei!'LG�GL �� .o <br /> � - Cc, � _ ,a , � 1 ggJC a � <br /> Vq ECT�OOqESS �PP�ICANi5GTY0U5MES5lICEM3EN0. f S <br /> w w <br /> y7�lo �'D�.F s Y' 7J/¢ / ' � `" <br /> � <br /> PLUMBINO MECHANICAL �S <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE � m <br /> WATER CLOSETITOILE7) 41F7 COND.UNITS-H.P.EA = <br /> BATHTUB REFRIOERhTION UNITS-H.P.E0. m N � <br /> LFVATORY WASN BASIN) BOiLERS-H.P.EA. O r <br /> � SHOWER GAS FIRED AC.UNI75-TONNAGE EA n m <br /> C N <br /> KITCHEN SINK6 DISP. FORCED AIR SVSTEMS-B.T.U. M EA m N <br /> DISHWASHER WALL HEF7ER5-B.T.U. M z c") <br /> LAUNDRYTRAV UNITHEATERS-B.7.U. M . � �i <br /> CLOTHES WASHER EVAPORATIVE COOLEHS p <br /> WATER HEATER CLOTHES DRVERS � <br /> URINAL VENTILATION FAN = <br /> _ D <br /> DRINKING FOUNTAIN RANGE HOOD = <br /> FLOOR DflAIN AIR HANDLING UNIT- C.F.M. � <br /> VACUUM BREAKERS S70VE .._. <br /> ROOF DRr11N5-RAINLEADERS METAL FIREPLACE 8 CHIMNEY y <br /> SINK SERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT Z <br /> O <br /> --1 <br /> � <br /> f9 <br /> m <br /> SUB TOTAL SUB TOTAL S <br /> PEHMI7 t _ PERMIT S <br /> TOTALFEE { _ TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> F,q�OJN,TASEtBACK � AEAflSE�TfBRGN SIDESETBACK PUNCHECKNUMBER PLANCHECNFEE <br /> ��{N��' b /� ( /_ � � ' TYG� FEE�� Z.(] PEC�I 0. <br /> � iy �_ <br /> U9E20NE /� LOTpRER y�CANTSITE <br /> ��I �YES BR� FEEB VI1LU�(ION FEE <br /> IYPEOFGONSi. OCCUPANCYGROUP NO.OFDVIELIINaUNIIS <br /> V— iJ /�/1 I BUILDINO s lZ83 �9 ZZ� O <br /> 512E OF BL00. N0.OF STJRIES M�%.OGG LO/�ND <br /> 44a C>�r � N/`� PLUMBING <br /> �� MECHFNICAL ' <br /> FIqE SPRINKLERS REO�IRED ❑ YES Q NO ' <br /> OTNER <br /> PENALTV <br /> RPPLICATION ACC.BY VLRNS CNECNEp BY APPR.FOR ISSURNCE BV /�/J ] <br /> L �I 70TqL (i (j Gp <br /> �c- :4+-r� n� <br />