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1�,:�'PLICATION FOk..� <br /> �n�Ewrpmn CO N STR U CTI O N °""°" <br /> CITY OF <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER M�IL�DORESS CITY ZIP PHONE <br /> � � ��T F�,9 l� F M e� ' .J PL� b'F"Q �y 8"ze� ��•,� -I l Y S� <br /> ♦RCHiiECIORD iOHEP M�IL�ODPE55 Cltt 21P PHONE ' <br /> :a-i RH�s � �•�J -7,_ s���v L u�ld scs� ss�'D <br /> GENER�L ONfl�pC10R M�IL�D�RE:S ITY ZIP PN NE L ENSE• <br /> �Ro'F� I U .��I 3�Zy-%Z srti� Tu ���F��zi 98zor �,;�5��17�7 <br /> MECIIANiWLCONiR�CiOq M�ILAODRESS CItY ZIP PI�ONE UCENS[• <br /> PLUMBINRCONip�GiOR M�IL�DORE55 CITV 21P PIIONE LI.;ENSE• <br /> CUSS OF WONK <br /> ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ 6UILD�NG RELOCATION <br /> veiueri{or+or won�K�c`ost or Mni[nie�s rws ueoni <br /> — I �.1� �V� <br /> DESCRIBE Y.Gnri <br /> l o' ! � {I D9 � i � o,J <br /> USE OF BUILDING � <br /> '�_ I ��n I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATIONAND KNOW THE SAMETO BE TRUE AND CORRECT.ALL <br /> IEO��7l�0E�5CRiPT10NOFPRpPEFTYI NOWNBELOWORAiT� NFOURCOPIES) pROVISION50FLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> �oi`^'�e�oc�or r�� ���'d��'��i�`' f���`I 'j� � OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE <br /> n GI EpAUTHOR TYTO VIO A�E OR CANICEL�THE PROV SSONS OF I <br /> —t�LfF-T S O F ��N(�M i S F� n ' OR THE P RFORMANCE OF CO STRUCTIOryNG CONSTRUCTION � <br /> SIGNATURE OF CON R TOR OR AUTHORIZED AGE T DATE I <br /> x � ` �l ,� , $7 ; <br /> VROJEGT�DDRESS �PPLIC�NTS USINE 4C NSENO. ! <br /> �7r3 r�� P s� �;, �� . , � <br /> PLUMBINO MECH ICAL I <br /> NO. TYPE OF FIXTUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(iOILEn pIR COND. UNITS—H.P.EA. <br /> BATHTUB qEFRIGERAT10N UNITS—H.P.EA. i <br /> LAVATORY�WASH BRSIN) i <br /> BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AC. UNITS-TONNAGE EA I <br /> KITCHEN SINK 8�ISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> OISHWASHER WALLHEATEfiS—B.T.U. M <br /> LAUNDRYTRAY � UNITHEA7EN5—B.T.U. M <br /> CLOTHES WASHER EVAPORATIb'E COOLERS <br /> WATER HEATER CLOTNES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUN7AIN RANGE HOOD <br /> FLOOR DRAIN AIR HAN�LING UNIT— GF.M. <br /> VAWUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE 8 CHIMNEV <br /> SINH�SEHVICE—BAR.ETC. WOODS70VE/FIREPLACE INSERT <br /> SUB TOTAL SUB TOTAL S <br /> PERMIT f pERM1T S <br /> __ TOTALFEE S CC� TOTALFEE 3 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �RONf5E1B�CK^ REMSEiB�CN SIpESETBACN PUNCHECKNUMBER (� PtANGMECNiEE <br /> d Q � �O � �� � '�J /�{ 7�I fEE /� � RECEIPTNO �/: DC/ <br /> VSE ZONE n LOT MU^ / ( V V / / U/(J O (O <br /> "�( V /D 3 U � O ESN�HO F ES V�LU�TION FEE <br /> n'�EOiC�j, OGCUPnNLYGROUP NO.OFOWELUNOUNITS BUIlDINO S � I SD <br /> v -,� R� ���• r�z � <br /> �:�ze or eioa NO Of SIORIES MA%.00C LOAO <br /> r E�J � Q.�. ' M� A � PLUMBINQ `Q Ct� <br /> K <br /> MECI IANICAL <br /> �IRE SPRINKLERS REOUIRED ❑ YES NO <br /> OTHER <br /> PENALTV <br /> '�PPUCAtION ACC BY PL�NS CNECNEO BY �PFO.FOR ISSU�NCE BY � _ <br /> � I ^_ ' /;� / , � TOTAL I 73 <br /> I%1 � <br />