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i��1f i— �Il./`1•�•'��N f V 1'!� everetl <br /> �`�"'"' CONSTRU(:���N e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- YLEASE PRiNT <br /> ❑ DEMOLITION �COMB�tJATION O BUILDING O MECHANICAL D PLUMBING ❑ SIGN <br /> OWMER M�I�ADDRE53 GI1Y ZIP VHONE <br /> i;..�....._. .1 G1,.,r.,,. ��� 2.:��b Colun� ��a C�der��ti 9S1_u3 3»-.5"•��; <br /> 11NCMIi[CIOIIOFlIONER M�iLAp�RE9! C�i'/ =�P FNONE <br /> t <br /> ��(Tl� <br /> OEN{,P�LCONiR�C10R MAIUODRE55 CIiY ZiP a1�ONE IICENSE• <br /> ��Ifl l� <br /> MLCNINIC�I GONIN�C10� AIAIL\pOPE05 CIfY . ZIP i'110NE LICENSE• <br /> QAm2 <br /> PLOMlINOCONIP�CTOR M�IL�DDRE59 ��n' =�P P��ONE IICENSE• <br /> �S(1 n�e. <br /> CLA35Of WORN <br /> ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRf�.INSEPT ❑ BUILDING RELOCATION <br /> V11W�LONOiWORN�C05o�M�l[iiqLSi'WSL�BOPo <br /> �1 5yUu0�� <br /> DESCNiBE WORK <br /> �iv�: 8A i rcem 4 e�rou� <br /> usE or euamNo <br /> �e .1�Q 1 HEREBY CERTIFV THAT I HAVE READ AN,� EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> LEO�l0E5CRIPi1^NOFPROPENIY�SIIOWNBELOWOA�iT�CNFOURGOPlE31 pHOVI510NSOFLAWSANDOR0INANCESGOVEHNINGIHISTYPE <br /> �S' Ib�lf�l3 " '� OFWORKWILLBECOMPLETEDWITNWHETHEASP[CIFIEDHERE• <br /> tor�e�octi.��or � � g IN OR NOT.TH'e GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAI_�AW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE Or CONSTRUCTION. <br /> SI�NATURE CONTR�CTG�OR RUTlIORIZED AGENT ORIE <br /> � ' , ' <br /> 3 ati ,�� X�i� � �r. '.�_. G������ <br /> OJECT�OOREF� �VPLIC�Ni9C1 BU51 ESSIILEN5EN0. <br /> PLUMlINO MECHANICAL <br /> Hp, TYVE Of FI%TURE F NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSEi�TOILET) AIN COND.UNITS—H.P.EA. _ <br /> 8�7MTUB REFRIGERATION UNITS—H.P. EA. __ <br /> LAVATORY�WASH BASIN� BOILERS—H.P.EA _ _ <br /> SHOWER GAS FIPED AC.UNITS—TONNAGE E0. <br /> KITCMEN SINK 8 DISP. FORCE�AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS—B.T.U. M _ _ <br /> LAUNDRV TR�V UNIT HEATERS—B.T.U. M _ <br /> CLOTHES WASHER EVAPORATIVE COOLERS _ <br /> WRTEN HERTER CLOTHES DRYERS <br /> URINAL VENIILATION FAN ' �-� <br /> DRINNINO FOUNTAIN RANGE HOOD __ _ <br /> i'.00R DR�IN AIR HANDLINO UNIT— GF.M. _ ___ <br /> V�CUUM BREAKERS S10VE <br /> ROOF OFM�NS—RAINLEADERS METAL FIREPL4CE 8 CHIMNEY __ <br /> SIN!:�SERVICE—BRR.ETC. WOODS70VE/FIREPLACE INSERT _ <br /> sue ror�� / sue ror�� s �i _.%r <br /> PERMIT f PERMIT f <br /> TOTAL FEE t TOTAL FEE f �__ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONI5EI0ACN AEMSEIB�CK SIOESEf �CK PUNCHECKNUMBER PL4NCHECNV[E <br /> � � � �� � fEE �i.' � �ECE�HQ���\ � <br /> � Z IO <br /> USE 20NE lOi�RE• V�GANT IiE <br /> �Z �.�; OYE5 �10 FEE9 V�LU�TION FEE <br /> �YPEOfCONST OCCUMNCYGOOIIP NO.OFDVI�LLINOUNI75 � �" <br /> �'� ��� BUILDINQ S � � <br /> S�ZE Of BLUO NO O�SIOPIES M�J[OCG LO�D <br /> // �� r��r„�� / �� PLUMBING J� �,�� <br /> b � �M•! ( <br /> MECHANIC�L (p �� � <br /> FIRE SPRINKLER" REOUIRED ❑YES NO <br /> OTHER <br /> PENALTY <br /> •PO�ICAIION�LC9Y ALANSCIIECKEOBY �PPR.FORISSU�NCEBY ^J� ��� <br /> TOTAL �I <br /> �_�� J� G, .G� — <br /> � ;�. r.;: <br /> ., <br />