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� <br /> ,1 <br /> " ��PPLICATION FOi;�'' <br /> '.. . �n.ewryrr�n everen <br /> :' °�T��°F CONSTRUCTION <br /> j everett PE R M I T � <br /> % BUILDING DEPARTMENT <br /> 259•8810 TO BE CONIPLETED IN INK- PLEASE PRINT <br /> '! ❑ DEMOLITION ❑ COMBINATION d�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ' OWi'PR MMI�D�HE59 CIiY ilP PNONE <br /> s ,�, � m�� c'����.a wm.�. So4 apiK� o� .p�.�i �eao3 �s�osoo <br /> ARLNIfCCi0R�E510NER c /1� AUIL�OORESS CI1Y ZIPI' PHO^N�E <br /> a��h� tqOQr�ISN �l�`<dAILF��sq �7`� �Vt—� �VM�N�3 ��IPv�d / /� O � LICENSE• <br /> ' �.�c.�l c�es�-�a, � "�o� gii�, a v►,,,��I�cb 4s.1�� �s�sa�ss �`''�oeLr�c. - <br /> �' MECH�NIGLCONiN�CiOq , M�IL�ppRE55 CItY IIP PHONE IIGENSE• <br /> PLUMBWOCONIf1�CIOR M�ILAOOAE55 Ci1Y 21P P�IONE lIC NSE• <br /> CU55Of WORN <br /> C� NEW L ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ \VOODSTOVE/FRPL.INS[RT ❑ BUILOING RELOCATION <br /> � V�lWT10NOFWORN�COSTOFM�IERI�LSPWSLA00R1 <br /> , <br /> I.S�.Ooo Oa <br /> OESCRiOE ORM <br /> u � <br /> .JqGW KQ_�an�G <br /> U9E Oi BUILDING <br /> i �,�i��C� � I HEREBY CERTIFY THAT ' HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME70 BETRUE AND CORRECT.ALl <br /> 'J IEO�L0E5LRIPTIONO�PROPENTY�SHOW ee�owoaatecNrounc viesr PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> �� �� OF WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> :' �oi�e�oc�_ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVI�IONS OF <br /> � _ ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> ,.' 09 THE PERFORMANCE OF CONSTRUCTION. <br /> •� SIGI'UTUPE OF CO'IIRpCTOR OR AUiNORIZEU AG[NT �4TE <br /> 1 <br /> P ,PROJEGT�ODRESS APP�IG�Ni5CII1'BU�NNI[NIO"\ � � Z� 1 <br /> � 6 lG ,Ed .u.r�r C.h <br /> ? . PWMBING MECHANICAL <br /> 3 ' NO. TYPE OF�'IXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT ' FEE <br /> � WATEFCLOSET�TOIIET) (� MC—A/HNOLCUNITS—M.P. <br /> y'� BATNTUB REFRIGERIITIONUNITS—H.P.EA. <br /> Si - UVATORV�WASMBASIN� �j BOIlERS—B.T.U.iM.P. <br /> .i ' <br /> � gN��R ' GAS FIRED A�C.UNITS—B.T.U. ' �' <br /> � ' � � KITCHEN SINK 8 DISP. fORCE�AIR SYSTEMS—D.T.U. ' M EA. <br /> �, DISMWASNER <br /> Q " I WAIL HEATERS—B.T.U. M <br /> t � � UUNDRYTR�Y UNITHEATERS—B.T.U. M <br /> � ' � CIOTHESWASMER � EVAPORATIVECOOLERS <br /> i ' URINAL ' ' CLOTHESDRVERS <br /> '(� • DRINNINGFOUNTAIN VENTILATIONFAN . � <br /> p` � FLOON ORAIN � ` + RANGE HO00 <br /> •;� � BACKFLOW PREVENTERS ' ' WATER HEATER : <br /> � ' ROOF ORAINS—RAINLEA�ERS _ WO00 STOVE <br /> S' � ( SINR�SERVICE—BAR.ETC.) 5 METALFIREPLACEBCNIMWEV <br /> � FIREPIACEINSERT <br /> .y <br /> :, ' " � � HEATPUMP <br /> y . . <br /> 5 � GAS PIPINO <br /> �� ' " - EXHAUSTFAN <br /> S! <br /> � ' SUlTOTAL f � SUOTOTAL ' <br /> 8 PERMIT f P[PMIT <br /> •i � � ' � TO7ALFEE f TOTALFEE � <br /> � iRONi SETB�GR ' . RE�R SET6eCK SIDE SETB�LK � PLAN CHE K NUMBER FEE � RECEIPT NO. <br /> .; �' � ��. .BsT �� 7 s � �7 I$�i 3 �� `� <br /> use zorp+e ��T�pEA y���NT SIIE FEES VALUATION FEE <br /> •' /l—S /7 9 es o�+o <br /> ' �T'PEOFCpNST. ' OCCUPANCYGROUP NO.OFOWELUNGUNITS BUILDING S�� /1/1�1 B`� <br /> I�71 <br />�} � " �`'� � � � J � PLUMBING e� <br /> ,SIZE OF BL04 ' N0.OF STORIES M�%.00C LOaU <br /> ;j ���� `L� ��/� MECHANICAL ` /L� <br /> y' <br /> � OTHER <br />� FIRE SPRINKLEfiS REOU�RED O VES NO STATE BUIL�ING SURCHARGE <br /> ^ STATEENERGYSURCHARGE <br />�� A4P��pAIION ACG OY PL�ry$CNEGNEO BY �PpP.fOR ISSU�NGE BY <br />�� PUBLIC WORKS <br /> t ��Aj\ �� L • G� TOTAI —J <br />' � ��� <br />'� PROPERTV OWNERSARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br /> . <br />