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�. \ <br /> � - � <br /> � APPLICATION FO�i everetl <br /> '".E"..°""" CONSTRUCTIQN � <br /> an oF <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING CEPT. <br /> 259-8745 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> M�IL�DORE53 Gltt ZIP PIIONE 34Z-sa Q�+� <br /> OWNEfl • • <br /> �20� .1�e5�r-�zld S��o Beauvna,t.t Dr E��v�tt qs�o3 as�-�46 � �o«� <br /> �RC ELTYR9E9i6NEA, . MAIL�ODRE55 CIiY ZIP PHONh <br /> n ,._ _��� � � h �,o �Lurnv-ri AuP I�C� Sr„-�i 2�1 �i�� 981� (o82-SSGG3 <br /> GENERA CONTR�CTOP ' � MRIL�DDNE55 Cltt ZIP PIIONE LICENSE <br /> �a3�o1 <br /> (;rn�e�a ,n'3�ru���n �'o. 16�11 �•Ul. 119� Sea-1�-(2 q8l�Eb �-�2�l4- 7y�o �► �aa�cc <br /> MEdUNIC�LC NTF�CTOq M�IL�DDRESS C1T7 °1Y _�d6N-S <br /> M 6-f' � � 'f3G� - <br />' PLUMBIN6CONTRA OR M�ILAODflE55 Lltt ZIP PNONE UCEN7E• <br /> i�a+ CIeS �'eCI <br /> I CUSS OF WORK <br /> i [� ryEW ❑ ADDITION ❑ ALTERATION ❑ REPAIfi ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION = <br />� W�WTION OF WOPK�COST OF M�TERULS PLUS L�BOH� O <br /> b �--� <br /> i � �ZD �20 n <br /> DESCRiBE WOFK � , . m <br /> SI'�w4�u�t' �i�ole {-'nrn�� rn5ld2nce. . <br /> i` useoFeuaou+—a� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- '""""' <br /> 1 � � p C PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL � T <br /> iea�� NIPiIONOFPROPETV15110WNBELOWORATT�GNFOURCOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE ""' � <br /> I ].� OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEOHERE• om <br />' �or •1 J BLOCIL�OF ����P ��r H� � S IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME'f0 <br />;i GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� m� <br /> <IDwY11VWOr�I N� ra�� E �u un� OR THE P RFORMANC�O�CO STRUCTIONNGCONSTRUCTION o m <br /> A L�C Y�I{'1 LO l T Q�Q t SIGNATURE OF CONTRPCTOR Ofl AUTMO ZED AGENT DATE _ � <br /> S-3�s zs�-4 !�/(S S `^ .. <br /> UG�. ll5 0�' .��rYb'n"S alS�t- al6 _ .o z <br /> c <br /> •PPLIG�NTSCIIY SINESSUCENSENO. � '""� <br /> PROJECTA�ORESS r = <br /> ��� ��� Ln�� _ = �, <br /> � <br /> PLUMBINO MECHANICAL � � <br /> G F <br /> NU. TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE �7 3 <br />. 3 WATER CLOSET(TOILET) CJ AIR COND. UNITS-H.P.EA. _ -� I'*1 <br /> REFRIGERATION UNITS-H.P.EA. _ <br />'� oZ BATMTUB m� <br /> IAVATOFVIWpSH BASIN) UOILERS-NP.EA. � <br /> O <br /> SHOWER ____ _ GAS FIHED AC.UNITS-TONNAGE EA O r <br /> -�-- ------ c� m <br />� HIfC11bN SINK6 UISP. Z— __- I UIII:LII�III_Y_ILM:i II 111 M I A . . . ._ "_. C V1 <br />� OISHWASHER OD WALL HEATERS-B.T.U. M �3*1 N <br /> LAUNORYTRAV UNITHEATERS-B.T.U. M �m <br /> CLOTHES WASHER OD EVAPORATIVE COOLERS <br /> WATER MEATER U � CLOTHES DRVERS S_� A <br /> 1 UFINAL B VENTILATION FAN � �� --1 <br /> I I RANGEMCOD d <br /> ORINKING FOUNTAIN n <br />'� AIR HANDLING 11NIT- C.P.M � <br /> FLOOR DRAIN � <br /> VACUUM OREAKERS STOVE _ <br /> ROOPORAINS-RAINLEADERS METALFIREPLACE6 CHIMNEV SO N <br />� SINK SERVICE-BAR,ETC. WOOOSTOVE/FIREPLACE INSEiiT — <br /> Z <br /> O <br /> .�-� <br /> fl <br />� m <br /> i SUB TOTAL �JO L7� SUB TOTAL 5 � �� <br />' . . PEAMIT 5 PERMIT S <br />� TOTAL FEE S �O �d TOTAL FEE S �(� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSUNNEL <br /> 9 ly� /I/� J� pJ� N RECEIPFENO <br /> FRONTSETB�CK OUFSETB�CN SIOESEIDN K PLANGIIEC NUMOER <br /> vI, U / �/ �S / / / �V FE[��0 O <br /> USE20NE LOTAflEA ! yAG�NT51iE FEES V�LII�iION FEE <br /> �� S ni,�J �/ j�'ES ONO <br /> TYPEO�ST. OGGUPANCYGROOP NO.O�DWEFLINGUNRS <br /> li-n� /S'- 3 � eui�oiNa s lZ$�1'LO, Sb5 S'� <br /> 512EOFBlD/O�. � / NOAFST�OcRIES .1 f MR%.00C LO D <br /> �I% !i S!'• 2'f'/J�QS��N!• I PLUMBING _ dO <br /> MECMANICAL � SO <br /> FIRE SPRINKLERS REOUIRED ❑YES NO oTMEfi <br /> PENFLTY <br /> APPLICATION�CC.OY PUNSCMECKEOOY �PPR.FOli15S1UNCE0Y � � <br /> TOIAL <br /> �.,Crp,� rlC F L • G . — _ <br />