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��-.PPLICATION FO::� ���,�„ <br /> '".E"'°'"" CONSTRUCTION � <br /> cin or <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COM8INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OW ER M�II�DDNE55 CILY 21P PNONE <br /> �t��� �Cr,�l� �(B�� d��Jfuz-EJ�' �8�3 34��309� <br /> �qCNItEpORDE5�6NER M�IL�UOnE55 CIIY 21P PNONE <br /> GE ER�LCONiPtG10R <br /> M�IL�DPRE53 CRY 21P PNONE ULENSE• <br /> - 1�AI� �� <br /> MECN�NIC�LCON1N�Ct0A MML�O�flE55 C�TY 21P PIIDNE ULENSE• <br /> PLUM9INOGONiR�Gi01i M�IL��Of1ESS GITY 21P PIIONE UCENSE� <br /> CL�SS OF WORN <br /> ❑ NEW ❑ ADDIT�ON ❑ ALIERATION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> VA WITION Of�W0111t ICOSf O�MRIE���LS PLUS L�BORI <br /> +X <br /> •Vfl <br /> oes��-o�P�i... �JINC\�S <br /> useor ew�ou+c � 1 HEREBY CERTIFY THAT I F'aVE READ AND EXAMINED THIS AP• <br /> -- �N '� ��^^ PLICATIONANDKNOK�THESAMETOBETRUEANDCORRECT.ALL <br /> tEf:�lDESGRIPT10NOFPROPEPfY�SHOWNBELOWO�� T�CMFOUFCOPIE51 PROVISIONSOFLAV/SANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE GOMPLETED WITH WHETHER SPECIFIED HERE- <br /> IOT�BIOCK�OF IN OR NOT.THE GR4NTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONqTUREOFCONTRACTORORAUTHORIZEDAGENT OAiE <br /> X <br /> PROJEGT AD�PESS �PPLIC�NTS CI1Y BUSINESS�ICENSE NO. <br /> " �}�SD 17W�-1�N }�n� N� <br /> PLUMBINO MECHA�lICAL <br /> NO. TVPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEP CLOSET(TOILEn AIR CONO.UNITS—lI.P.E0. <br /> BATHTUB PEFRIGERATION UNITS—N.P. EA. <br /> LAVATORV IWpSH BASINI BOILERS—H.P.EA. <br /> SNOWER GAS FIRED AC.UNITS—TONNAGE EA <br /> NITCHEN SINK 8 OISP. FOPCED AIR SVSTEMS—B.T.U. M EA. <br /> OISHWRSHER WALL HEATERS—B.T.U. M <br /> LAUNDRYTRAY UNITHEATERS—B.T.U. M <br /> CLOiHES WASHER EVAPORATI�'E COOLERS <br /> WATER MEATEP I;LOTHES ORYERS <br /> URINAI VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIL— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF ORRINS—RAINLEADERS METAL FIREPLACE d CHIMNEY <br /> SINK SERVICE—BAR.ETC. WOODSTOVE/FIqEPLACE INSERT <br /> SUBTOTAL SUBTOTAL s <br /> PEFMIT f PEHMIT s <br /> TOTl1l FEE 3 TOTAL FEE s <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONT5EI8�CK �EARSEIB�CK SI�ESETBAGK PL�NCHEGNNUMBEN VUNGNECNfEE <br /> FEE RECEIPI NO � � <br /> ❑SEZONE LOIME� V�C�NTSITE FEES WLUATION FEE <br /> OYES ONO <br /> TYPEOfCONST OCCUPANCVGROUP NO.OFOWElLIN0UN113 S� S(�VL I 5 <br /> BUILOINO f � <br /> S4E OF OLOG NO Of$fOPIES M�R OCG.LO�O <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS RE�UIRED ❑YES O NO OTHEn <br /> PENPLTY <br /> ♦1'PlIC�110NACCBV �UNSC��ECHEOBY �PPR.FO�ISSUANCEBY �� � ^\ <br /> TOT�L �� <br /> �n ;�- � G -C , <br />