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� <br /> �1PPLICATION F�.� <br /> fM ErNpnM C O N ST R U CT I O N c`�"H <br /> cirr or <br /> everett PERMIT • <br /> � TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 � COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br /> �wHrn . M•aeooaess cnv zu� r����Nr <br /> � (j <br /> Ji�-vEv1 .� �107f nVl �l __•.Y.:.� :� ^ 1i. v.•�i��.: i � VFrC,�� ;'/I:7 ':S�)(,3 -� �' . i . (' 1 <br /> . nO�NItEGf�rlOCSWNER M�ICAODRESS;� Clfv . 1410N! <br /> f,:� 11� L � <br /> 4EN[R�l GONiR�CIOR MMl�ODRE55 CITY IiP PHOH` UGCNSE• <br /> MEGHaNICAI CONiR�GTOq MAII�DDRE55 CiTY ZIP PnONE LICENSE• <br /> o�UMBiNOCONTP�CtOR M�IL�OD11ES5 CiIV SIP P��ONE L�CENSE• <br /> ii J <br /> l to ri ��vni 1 �� /[L'3`J �'{av1' C�JPrP_{, �� ZQ � �S�iJ�i - -� �(t� �l <br /> Cl�sSor ORR <br /> ❑ NEW ❑ ADDiTION �i hLTEFATION ❑ REPAIR ❑ DEAIOLITION .C� WOODS70VE/FRPL.INSERT G BUILDING RELOCAiION <br /> iLL W tiON 0�WOAN ICO51 OF M�TERI�lS PLUS I�BORI <br /> ✓ 1 .1 ���7 <br /> �' � — <br /> ^FSCRig!WOAN <br /> 1 �f <br /> • Ip :� :•) I !i0 P f '� 9�1: )O'M1� I �. �A �! :1!/ f�( nE�CATf' V `4li�('i: 'C� ./f1Y�:i.7� ✓ <br /> �5f Uf BWID��IG <br /> + I HEREBY CERTIFY THAT I HAVE- READ AND EXAMINED THIS AP- <br /> ' "11 �'" PUCATIONA�DKNCWTHESAMETOBETRUEANDCORRECT.ALL <br /> LE6�LDESGRiP110NOFPRpPERTYI9MOWNBELOWOA�ITACHfOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- � <br /> �or_e�oc�—or_ IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO ' <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� � <br /> ANY OTHER STATE OR L OCAL LAW FEGULATING CONSTRIICTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> SIGNAIURE OF CONTRACiOP OR RUf110RIZE�AGENi DAIE ' <br /> � � <br /> / � ) /� i / � 'O � <br /> Ci O` .J � COu.�. F J ( n I V � X ._��.0 L �;� `V'U.-�{-V .��� ' Z <br /> �ROJEC��OORE55 �PPIICRNI'SCIfY S�N[SSLICCNSEND � <br /> � <br /> PLUMBIN6 MECHANICAL _ � <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMEHT _ FEE I <br /> WATERCLOSET�TOIIEI) _ _Q AIRCOND UNITS_NP EA _ _ ___ � <br /> B�THTUB ____ '� �Q REFRIGERAIION UNRS=H V_EA _ _ � <br /> _ L�VATORYIWASHBASINI _a b tlOILERS-HP [A_ _' � "_'_ _ "'_'__ � <br /> S��OWER GASFIREDAC UNI7S-TONN4GEE� <br /> ' '— ___' _'_'_—"_"_'_—.._..._.___ .. . __..'_"_ _ � <br /> NOCHEN SINKB DISP. fORCED AIR SY$iEMS-�i U M EA. � <br /> DISHWASHER WALI NCATERS=B T U. M ___ ! � <br /> _ LAUNDRYTR�V UNITHEATERS-B.TU M___ _ j <br /> CLOTNES WASNER EVAPOFATIVE COOLERS ' <br /> WATER 11E�TER O f.LOTHES DRVERS ' � <br /> "' '_—__'__ _— 1 <br /> UFIN�I VENTqqTION FAN � <br /> ORINKING FOUNTAIN RANGF NOO� <br /> FLOOR CRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIFEPLACE d CHIMNEV <br /> SINK SERVICE—BAR.ETC. WOODSTOVE/PIREPLPCE INSFRI _ _ ___� 3a_ � <br /> SUB TOT11L LYf SUB TOTRL � S v ' <br /> � __ ____— . —___ _ _ . _'."_.� _'_ <br /> PERMIT f PERMIT f <br /> TOTAIFGE f O TOTALFEE_ 6 a '• <br /> — —__ S <br /> TH15 PORTION 1'O BE COMPLETED BY BUILDING DEPT. PERSONNEL � <br /> t <br /> n10NISEIBACN RE�RSEfB�CK SIDESEIBeCt PI�NQIfCNNUMpER rvAN1���4f.Nf�E <br /> � !EE I I1EGC��I NO ` <br /> USELONE LOT�RE� � � <br /> VACANT,^•��E FEE� VIIWATIOH FFE <br /> [I�ES t7h0 <br /> rvpEOFWNST OGGUP�NCYGROUP NOAFDWEILINGlINI1S <br /> i <br /> BU�l01NG S • � � <br /> SiiE OF BIDG M0.OF S10RIE9 MA%OCC �OAD <br /> PLUM�ING 4' Q6 � <br /> MECMANICAI —'— D <br /> L FIRE SPRINKLERS REOUIRED ❑ VES ❑ NO — <br /> O7NEN <br /> f <br /> PENAIIV — ---_— � <br /> APPUG�110N�CC OY PLANSCMEGMEOBY �f'PR FORI,95UANCEBY � _ � <br /> TOTAL s � • <br /> 4� <br />