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�,_�PPLICATION FO;.._� eVPfC„ <br /> I�sErnqrl�n CONSTRI�CTIUN <br /> Gry OF � <br /> everett PER�iiT <br /> BUILDING DEPARTMENT <br /> 259�8745 TO 8E COMPLETEU IN INK• PLEQSE PRINT <br /> ❑ DEMOLITION ❑ COMBONATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SiGN <br /> UWN[f1 MqLADOf1E55 CIP! ZIP PMONE <br /> I�av,ta�� v /Iss oc ; ida3 f✓eie/f i✓lal( Gt/a.� S.C-- l�v`Gta� �vi? `I ��D� <br /> +ncHnecioaocsim+en M�ILFDORE55 �cirv zm r��or+e <br /> .t�lE��ICONIRACIOR MPII��UFE55 CiiY LP PHONE LICE1lSE • <br /> IAf f.11ANIC,A�COIItO�CIOf� M�IL AOORE55 CIIY ZIP PHONE �J _ l./ I�E��SC� <br /> 'vR �rUG-Q r�Lv1 L�0(�-t;r141Pef� �' • lue /�ed .S � /y/LjAivi� U. as{/ .�r �faC�, / � ! <br /> ��WA�IIiN�iCONIb�ClOq--C MAIL�ODPE55 CIiY 21P PIIONE IICE��SE• <br /> CU550�WCRN <br /> I_I NEW ❑ nDD!710N ❑ ALTERA710N ❑ REPAIfi ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERi ❑ BUILDING RELOCATION <br /> ,<ivarior�or vranK�coet or ree¢nuis rws uooni <br /> ut scnN[wonK <br /> "rn.T iu-E2- c(�i rc�cP-�rp a��el�r/r�Z N�Ac u��fs wl�ela�ncP cfas ,��� <br /> �r.a .v,@winum � <br /> rl' i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> ('�-� IZi I PLICATIONANL`ni.OWTHESAMETOBETRUEANDCORRECT.ALI <br /> ��io�in�scniruorrovrnorenrvisiuwuonowonenecurouncowesi pRpVISIONSOPLAVv�SANDORDINANCFSGOVERNINGTHISTYPE <br /> OF WOP.K WILL BE CC�MPLETED WITH WfiETfiERSP:=CIfIED FIERE- <br /> �oi.._oiocK_ov M OR NOT.THE GRANTING OF A PERMIT DOES NOi PRESUME TO <br /> GIVE AUTHORITY TO VIOL�TE OR CANCEL TIiE PROVISIONS OF <br /> '^IY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> —' �. 2 THE PERFORMANCE OF CONSTRUCTION. <br /> . JGNATURE OF CONiRACTOB OR�Ui1tONZED�GENf U41E <br /> c � � --4, , �� . �-,��.� -� l� <br /> rfiO1EC1�ODf1E55 APPLICA�IiSCItY�i ME SLiCENSEND <br /> Ir.%O ?i �J('/PlY" {t��G/� .rF _ <br /> PLUMBING MECHANICAL _ <br /> NO. TY7E OFfIXTURE FEE NO. TYPE OFEOUIPMENT FEE <br /> WAfER LLOSEi�TOIL[T) AIR COND. UNITS—H.P.EA. <br /> BAIHiUB REFRIGERATION UNITS—II.P.EA. <br /> LAVAipRY�WASH 6ASW) DOILEfiS—H.P.EA. <br /> SHOWER GAS FIf7ED A.C. ��'�TS—TONNAGE EA _ <br /> KlTCHEN SINN 6 D�SV. FO�CEO AIR SYSi[MS—B.T.U. M EA. <br /> DISIIWASIIER WALL HEATERS—B.T.U. ht _ <br /> LAUNDRY TRAV UNIT HEATERS—B.T.U. h7 _ _ <br /> CLOTHES WASHER EVAPORA7IVE COOLERS <br /> WATERIIEAiER CLOTIIES ORYERS <br /> U�7INAL VENIILATION FAN <br /> pRINKING FOUNTAM MNGE HOOD _ __ <br /> FLOOR Df1AIN AIR HANDLING UNIT— C.F.M. _ __ _ <br /> VACUUM�REANERS STOVE _. . <br /> flOOF OflAINS—PAINLEADERS MC-TAL FIflEPLACE 8 CHIMNEY _ <br /> SINK�SEFVICE—BAR.EiC. WODDSTOVE/FIREPLACEINSERT _ _ <br /> _ -- �.�-=1.�9�I��z-w�, - -- <br /> SUBTOTAL SU�TOTAL S <br /> PEflM1T 5 PERMIT S <br /> TOiAL FEE S TOTAL FEE S ____ <br /> T:-IIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �NONt SE�OACN REpR SEIp�CH SIOE SF.IPRCK �IAN CHECN NUMOEO FLAN CnECH f[[ <br /> FEE �[CEiPf NO <br /> u5E ZOrvE LOf Pf1E� yqCANT SITE <br /> FEES VALUATION fEE <br /> ❑YES �NO . --- <br /> �rrEOfCON51 OGLUPANGYGf10UP NO.OFpWELLINOUNIIS _ <br /> OUIL�ING S <br /> rdt E OI OLUG NO O�90lt1f.5 MRX OCG LOAO -- <br /> PlUM81NG <br /> MECIIANICAL <br /> I�IRE SPRINKLEFS REOUIRED ❑ YES �7 NO <br /> OTHF.R <br /> PENALTY <br /> 4PPIICRIIOIIACG BY 1'LRNSL'IECNECOY APPR.FOF�SSU4NCE�V ----'-- <br /> TOTAL <br />