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7 F " . <br /> �� �, -�'.. �PLICATION FOR� . ���,�„ <br /> .: �ME,� CONSTRUCTiON . , -: ` i � �: e <br /> ` an or <br /> `` .everett PE Rn�l tT <br /> .�BUILDINC�DEPARTMENT TO BE COMPLETED IN INK• PLEASE PRINT <br /> 269•8810 • <br /> ' '�'�O DEMOLITION O COMBINAT�ON ❑ BUILDI�'Z', ❑ MECHANICAL � ` � PLUMBING �� ' O�SIGN <br /> OWNER . M�IlA0UPE55 Cltt 21P - PNONE � . .'J: ` •�� <br /> TNB HO SEiFFERT Co 2s�oo N�ov��f Aui Gvfir�:i 98�oG z59-S/o� �� <br /> ARGMITECTON�E816NEN , � MAll�00RES4 CIIV 21P PHONE <br /> GENEMLLUNTRAGTOR M�IL�ODPESS Cltt i�P .._. PHONE UCENSE• <br /> � � <br /> �fl,c I�✓1 . <br /> MECHANIGICONTMCTOfi MML�OORE55 CI1V ZIP PHONE � , , .,I,G[NSE <br /> � PLUMBINOGONiR�GiON MMIA�OpE54 Cltt 21P PIIONE � � UCENSE� <br /> � CL�DlOFWORR . ' . <br /> � ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUIL�INO RELOCATION <br /> � y��p�TIpN OI WORN ICOST OF M�T RI LS PLU9 UBOR1 - <br /> �� .J I�V•d <br /> � OE6CNilE WORM . � <br /> O!/N Tie K/Fi' /N6 <br /> uecoreuaoiNa � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED-THIS AP- <br /> ff/�' � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> ' LEOALDE9GRIP110NOFPROVERiV19NOWNBELOWORAITACMFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � q� OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED�HEFlE• <br /> �,�.��LpT ���BLOCKL ��.OF E o Co:s .+ INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br /> j� �; � Fs ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> ;;, OR THE PERFORMANCE OF CONSTRUCTION. ' �� / ry <br /> 1 ��/ CO� �//( p SIONATURE OF% TRACTOR OR AUTH RIZED A6ENT D�1E •�/�dleo <br /> ���•• � ���L�/`(� <br /> '►RQIECT�DORElB APPLI A SGITYBUSINE59LIGEN9EN0 <br /> '2 936 Fut roN �,S't- <br /> PLUMBING ' MECHANICAL <br /> - NO. T'PE Of fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FE! <br /> WATER CLOSET(TOILET NC-NHNDLG UNITS-H.P. <br /> `?`�« . BATNTUB REFRIGERATIONUNIT$-H.P.EA. <br /> �� . <br /> UVATOPY 1 WASH BASINI BOtLERS-B.T,U./H.P. �_ <br /> ���;,:.. . �Q�R , GAS FIRED A.C.UNITS-B.T.U. � <br /> KITr,MEN SINK 8 DISP. FOHCED AIH SYSTEMS-B.T.U. M EA. _ <br /> � DISMWASMEH ' WALLHEATERS-B.T.U. �M <br /> '�'?�'����^ UUNDRYTR , ' • UNITMEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> � " � -URINAL ' � CIOTMESDRYERS <br /> � ORINKINQ FOUNTAIN VENTIUTION FAN <br /> � FLOOR DRAIK� � RANOE HOOD <br /> . 'BACI(RQWPHEVENTERS` WATEPHEATER <br /> �.j�'n ROOFDRAINS-RAINLEA�!ERS wOODSTOVE � <br /> '��' � 31NK�SERVICE-BAH,ETC.; MEfAL FIREPI.ACE 6 CHIMNEV <br /> � � FIPEPLACEINSERT <br /> � . � HEATPUMP <br /> � - -. . OAS PIPIN6 <br /> � • ' E%H�USTFAN � <br /> fUETOTAL f lUSTOTAL ' �� � <br /> � PERMIT f P[11YIT <br /> TOTALfE! f TOTALFlE <br /> iRONT SETB�CN � AE�R 9ETB�CK SI�E SEiB�GIt PIAN ECK NUMBER FEE RECEIPT NO. <br /> :� , ._ , gg�'�4�a�7 q�353 <br /> � use�l� IOTARE� G9Z yAC�N�re FEES VAWATION FE! <br /> � �CP� OYES O ' - S • � W <br /> BUILOING <br /> �FGON4T. OCWV�NGYGROUP NOAFUWELLINOUNIiS <br /> Nir'.�� /g�Z, '!9" PLUMBING <br /> � $REOfBlDO. NO.OFSTORIE9 MA%OCC.IOAD MECHANICAL <br /> �o^� 5.� / /`�A S 8'S <br /> OTHER � <br /> FIRE SPRINKLERS HEOUIRED ❑ YES �NO STATE BUILDING SURCHARGE 3 S <br /> � <br /> STATEENERGYSURCHARGE <br /> AVPIIC�iION�GC B� PLANS CNEGKEO BY APFP.FOF ISSU�NGE BY PUBLIC WORKS <br /> � �„ � TOTAL � <br /> ,f PROPERiYOWNERS AFiE RESPONSIBLE FOR DETERMINING ALL <br /> � . PROPERTV LINE LOCATIONSAND RELATED EASEMENTS. <br /> � (^ `,., .1�.. �.'.'.:i�.1'A.4 ' " C�l�.N� � . .� .. _ . . . . � <br /> p+�.�[ .Yr�+1 `C T t .. , r. . �," y:? '�, ,.... .1 . 1,.� J4.` •�(I� <br /> � 1. ^ <br />