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`, �PPLICATION f0�. � everclt <br /> '".E"ro"'" CONSTRUCTIUN e <br /> ��n oF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•87a5 TO BE COMPLETED IN INK• PLEA4E PRINT <br /> i <br /> MOLITION ❑ COMBINATION 6'9UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> Ep /� M1� (�OORE53 ,,�1 Cltt 21P VHONE <br /> �NILIf JCF �iIJK �3y'z ��lt�tK��EO }�' Vi� �.rreFT �ly'?03 3?�-/'?�''"z <br /> �PCHITECT�ESIONER M�ILAD�PE55 CITY 21P PNONE <br /> OENER�LGONTR�Gf08 M�IL�O�AE55 C17Y ZIP PMONE LICENSE• <br /> � <br /> MEGN�NIG�IG�p�CTOq M�Il�0�AE93 CITY I�P PNONE ULENSE• <br /> PLUMBI�NTR�C R M�IL AODRE55 GITY ZIP PI/ONE IICENSE• I <br /> GL�SS OF WORI(� I <br /> ❑ NEW ❑ ADDITION ALTERATION REPAIR ❑ DEMOiITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�IU�TION OF WOnK ICOST OF M� ENqlS PLVS UBOPo <br /> OESCNiBE W K ' � � / <br /> l � Y Ire 1 1�'✓� 1.� CLi1'�� ) S ��'tE�� <br /> useor ao I HEREBY CERTIFY THAT I AVE READ AND EXAMINED THIS AP• <br /> �'J ( + U �✓� � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEO�LDESGRIP110NOFPROPE TY�SMOWNBELOWONAT111CHFOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYFE <br /> OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE• <br /> �or—e�oc�.—oa IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> � �J, GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> N 2. Gl �-ILT�O VLVD ORTHEHP RFORMA�N E�OFCO STRUCTIONNGCONSTRUCTION �i <br /> SIONATURE OF CONTRACTOR OR AUTHORIZEO/CENi OATE <br /> X ...i'( ! ��� � /� �� <br /> PPOJEGT�ODRESS APFLIC�NiSCITYBU51 SSIiLEN5EN0. ' � <br /> PLUMBINO MECH�NICAL <br /> NO. TYPE OF FI%TUHE FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE7) AIR CONO.UNITS—H.P.EA. <br /> BATHT 8 REF IGERATION UNITS—H.P.EA __ <br /> L�VATOR �NRSH BASIN) BOILE H.P.E0. <br /> SHOWER OAS FIR AC.UNI15—TONNAGE EA <br /> NITCHEN SINK DISP. FGRCED AI SYSTEMS—B.T.U. M EA. <br /> DISfIWASHER WALL HEAT S—B.T.U. M <br /> LRUNORYTRAV UNITHEAiER BT.U. M <br /> CLOiHES WASHER EVAPORATIVE C'OLEFS � <br /> WpTER HE�iER CLOTHES ORVER — <br /> URINRL VENTILATION FAN <br /> ORINKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDIING UNIT .F.M. <br /> VACUUM BREAK S SiOVE <br /> ROOF DRAIN RAINLEA�ER METAL FIREP CE 6 CHIMN <br /> SINN SERV E—BAR,ETC. WOODST E/FIREPLACE INSE T <br /> SUB TOTAL SUB TOTIIL s — <br /> PERMIT 3 PEHMIi s <br /> TOTALFEE t TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fPONfSETB�CN REARSEfB1CK SIOESEiB�LN <br /> VL�N CNECK NUMDER {'L�N C��ECK iEE <br /> F[E PECEIPf NO <br /> USE20NE �QT��E� y�LANT5ITE FEES VA�V�TION fEE <br /> OYES ONO /,/f / ��� <br /> TYPEOFCONST. OLCUP�NCYGROUP NOAFOWELlIN0UN175 ld� a - '�`� ' L� �}� <br /> BUILDINO S � '� �/ �' �/ <br /> SIIE OF BLD�. NO.OF StONES . M�%.00G LOAD <br /> PLUMBINQ <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES O NO OiNER <br /> PENALTY <br /> APPUCRt10NACC.OY VUNSCHECNEDBY APPRi0RI55UANGEOY /JU , ,\ <br /> TOTAL � �� <br /> I <br />