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';_,PPLICATION FO�.�' ���,�„ <br /> '".E"'°'"° CONSTRUCTION O <br /> cm os <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE C.AMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION '�E3BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OW ER MMUODRESS CIIY ZIP PNONE <br /> , ,/ r7z4 Eqsy Sr• <br /> � TH t�EL/LA �N {7��(rNH/LEN fyG�PE.r�t <br /> �11CHt1EGTO�0E5i �EN MAIL�DDR[SS ��ry z1P P���N� Sro.e�+c-i63ar <br /> �QS' � sr�rr�trrav ./331 i24r+,f �G. �/E.N�A�'YSl�/�LE �6'27d 15.��9 <br /> ENER�LGONiR�GION M�Il�0�RE5S CITY 2�P PNONE L�CENSE• <br /> MECN�NIUI CONIR�CTOq MAIL�OOFESS CRY ZIP PNONE LILENSE• <br /> FLUMBINOGONiR��IOR M�II�D�RE59 CIIY 21P PIIONE UCENSE• <br /> CL�SSOf WOtiK <br /> ❑ NEW ❑ ADDITION ❑ ALiERATION REPAIii ❑ DEMOLI7IDN ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDtNG RElOCA1�ON <br /> vllw�rloN or woRRP.oSt oF N��[Nuts rWs L�BORI <br /> � <br /> �/� ' <br /> ❑E9GRiUC'vORN <br /> � v - F� - - 9 - - -Fo � <br /> USEO[BUILDINO /� I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �N�L� 11�f/�A� PLICATIONANOKNOWiHESAMETOBETRUEANDCORRECT.ALL <br /> IEO�LOESCRIPLONOFPR0�Ei11V�5MOWN0ELOWORAft�CNi0U11COVIES� pqOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> Of WORK WILL BE COMPLEiED WITH WHcTHER SPECIFIED HERE- <br /> �or_e�oc�—o� IN OR NOT.THE GRANTING Of-A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSiP.UCTION. <br /> SIONATURE OF ACTOII O AUTHp 2ED AGENT UATE <br /> X <br /> pROJECT�D0�E55 �V � �NTSCItV USINES lIG[NSENO <br /> 77z4 EAs,� ��c��'r <br /> GLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSC-T(TOILEn AIH LON�.UNITS–H.P.EA. <br /> BAIHTUB REFRIGERATION UNIiS–H.P.EA. <br /> �pVATORYIWASH BASINI BOILERS–H.P.EA. <br /> SHOWER GAS FIREO AC.UNITS–TONNAGE EA <br /> NITCHEN SINK 8 OISP. FORCED AIR SVSTEMS–B.T.U. M EA. <br /> DISNWASNER WALLHEATERS–B.T.U. M <br /> LAUNDRYTRAV UNITHEAiERS–B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WAIER HEATER CLOTMES ORYEPS _ <br /> �q���p� VENTIIATION FAN <br /> DRINKINO FOUNTAIN RANGE HOOD <br /> FLOOR ORAIN A�R NANDLIN6 UNIT– C.F.M. <br /> VACUUM BPEAKERS STOVE <br /> ROOF DRAINS–RAINIEADEPS METAI FIREPUCE 8 CNIMNEV <br /> SINK�SE9VICE–BnR.ETC. `NOODSTOVE/FIREPLACE INSERi <br /> SUBTOTRL SUB�OTAL 3 <br /> PERMIT t PERMIT : <br /> TOTAL FEE f TOTl1l FEE s <br /> THIS PORTION TO BE �OMPLETEU BY BUILDING DEPT. PERSONNEL <br /> �ROMS[IDACN RWf15[IpRCN SIDESEfB�CN �UNGMECI(NUMOER 1'UNCII[CKiEE <br /> iEE �ECEIPf NO <br /> US[20NE lOUPU V�CANTSIIE FEES VAWIITION FEE <br /> ❑Y[S f]NO J <br /> �n �, L.. <br /> IYPEOFCONSf OCCUPANCYGROUP NO.OFOWELLINOUNIIS �) � � � <br /> 9UILDINO 3 �1 I��J�� (,. <br /> SiZE O!B1�0 NO Of 510��E5 MR%OCG LOAO <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPR�NKLERS REOUIRED ❑YES ❑NO <br /> OTNER <br /> PENALTY <br /> API'lIC�110t1 ACG pY �lANS Cl1[CNEO OY �t'PR FOP i55U�NCE BY �o o ` <br /> TOTAL <br /> � <br /> \i <br /> ,_ . , � 7; � ,'9_ ' <br />