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4racPPLICATION FOIr�' <br /> '".E"'°`"° CONSTRUCTION "`�"an <br /> cin oc <br /> everett PfRMIT <br /> BUILDING OEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING RMECHANICAL �'FLUMBING ❑SIGN <br /> O�\��ER MfAL�DORNS CITY ZIP PIIONE <br /> G'��v /�%/�«.l�n,S�. z.33o�� .�v 9� ��,�oa�rl 9�vzv �7��-oirz <br /> �nc�� �/Lfo.lSL��ti'S /!'P M/ K/ p�OK �� hJ / I/G.� �zJJC72 PIION� Og' ��fOv <br /> ,l/7r'i Ay//�� ( <br /> OENEHAI LONLRaC10R MRIL�DO E53 CItY EIP PNONE LICENSE• <br /> �o��oli,i/Li�,..l��s�. 2330 � i�ad 9�' E�sx�� �s���z�v�z�srx-c�HEtvc'����ss..r� <br /> MEWI NIGIGONiR Cipq MML�OONE55 CITV ZIP PIIONE UGENSE� <br /> Q//e �tuc� /-�s //3.23 �/�u 99 .Eve�� -98za y 3ss--��3o V�lLENCi3�3lr' <br /> GLUMBiN�f.ONiP�GfO,yfl - MML�DORE55 —� CIIY ZIP PHONE LiCENSE• <br /> �j .� /(EP.��u r Ci�� /a'�x /O���. N. .L�t/�,ve.,,r.f �ROZO ZG C�GL3.�•�iT/]�e�•er _ <br /> a�ssorwonK lT� /�/ <br /> �. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR C� DEMOLIT�ON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�L WTIJN OF WORR I�OST Of AIA1 CRIAL 5 PLUS LABORI <br /> �,1�'�LOOIJ— -- <br /> DESCPiBE WORN //- <br /> �?f_i9e M��S�' <br /> USE OF BU DINO ^ - <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW T4E SAME TO BE TRUE AND CORRECT.ALL <br /> LEO�l�E4CRIPfIDNOFPNOPERTv�SNOWNpELOWORATT�CNFOIINCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �orJl_e�ocK_or � IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIV°AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �� (' ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUR ONiRACTOR OR AUTHORIZED AGENT OATE <br /> X /1- 3" 6 <br /> p�JEG��ppqE55 ♦'� �PPL SG BUSINESSL ENSCNO. � <br /> � S E G <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMEN7 FEE <br /> WAiER CLOSET�TOILET) � 00 AIR COND.UNITS—H.P.EA. <br /> BA7HTUB pU REFRIGERATION UNITS—H.P.EA. <br /> 3 LAVAiORY�WASHBASIN� D BOILEFS—H.P.EA. <br /> / SHOWER � O GAS FIRED AC.UNI7S—TONNAGE EA <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. OD <br /> � DISHWASHER WALL HEATERS—B.T.U. M _ <br /> LAUNDRViRAV UNITHEATERS—B.T.U. M <br /> � CLOTHES WASk/EF U EVAPORATIVE COOLERS <br /> WATERIIEATER I CLOTNES DRVERS � <br /> URINAL VENTIIATION FAN �' � O <br /> DRINKING FOUNTAIN RANGE HOO� rJ <br /> FIOOR DRAIN AIR HANOLING UNIT— C.F.M. <br /> VACUUM 6REf.KERS STOVE <br /> ROOF DRAINS—RAINLE�DERS METAL F�REPL4CE 8 CHIMNEV <br /> SINK�SERVICE—BAR,E1C. WOODS70VE/FIREPLACE INSERT <br /> � wa "a <br /> SUB TOTAL O OO SUB TOTAL S <br /> PENMIT S PERMIT f <br /> TOTALFEE 3 TOTAIFEE f �OC <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL u � <br /> �RONI SEIO�CK �EPR SEIORCK SIOE SETUACN PIRN CNECN NUMBEB PLAN CIIECN fEE <br /> zv z � G �6 �� �7J 55 �E��OI °�' �.���8 <br /> USE ZONE LOi AREF y�CRNT SITE <br /> ��� 3�� y y� OYES ONO J ,,, FEES V�LU�TION FEE �� <br /> TVt+E CONST OCCUPRNGVGROUP NOAF�WELLINQUNITS CJ'� �, ���f <br /> SIZE Of BL� �� NO Of StOniES M�X O G.LO�D BUILDINQ 19� �l/ J . <br /> 1'1eL/ <br /> /�Jq� ./ /'A� �J rr PLUMOING O yv <br /> // TLf/T — <br /> MECHANICAL <br /> FIRE SPRINKLERS FEOUIRED O YES ❑ NO <br /> OTHER <br /> nPPIiCAiIONACC BY PLNISCRECREOOY APVq.FORISSU�NCEOV PENRLTY �l �1` t� . V r\�_ <br /> l �] � <br /> L,� ' TOTAI � / C.� L_ Z <br /> 5� �� <br />