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,�.E..,,,,,� '���PP�.ICATI�N F4�.1 tYffe„ <br /> C�n'OF CONSTRUCTION � <br /> everett � PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION O C0111BINATION ❑ "e.'.UILDING ❑ MECHANICAL �PLUMBING ❑ SIGN <br /> OWNEf1 MAILA�OfiE55 �(L. ��. CIIY i1P PHUNE <br /> - 15 io �Y�<, /,aC13 Y=. —d��.�,/L�aI�/,C��� FL�rc=/� (��A _ <br /> Fa wiCClOn0E510�1En A1�IL�DORE33 N I ZI� c�lONc <br /> GENCfULLON�IUGfOR MAILAOpf1E59 CIfV ZIP PIIONC tIC[NSE• <br /> MECIUNIUICCNIMGIOq M�ILPODf1E55 CIIY ZIP PIIONE UCCN`vf• <br /> 2'Ak O�I�M��� <br /> �PLUMRliLONiP�CIG� •— MTIIAI`ORESS LIIV ZIP PI�ONL LIC[NSC • <br /> ��zc � �r�.��.c�r-/ �O 1�.t�c r�l'�� L;�N1a,�.�/s 9fiD�c;-U��� !7G-G ZcXJ /�5''/r 9 <br /> ��.,55�F W�nK <br /> �I NEW ❑ AD�ITION L� ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ 'h'OODSTOVE/FNPL.INSERT ❑ BUILDING RELOCATIGN <br /> V�1U�110 Of WO�RICOS]Of MRl[RIPLS{'WSLABOfiI <br /> � ���1��)` � - <br /> UEscniDE o��R n �.� . /. <br /> "Lo . . l ' '" � �' r 7 — .l — E.- , _ <. /' ) / . -(t' <br /> useor uanu � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE�THIS AP� <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORR[CT.ALl <br /> ICG�L0E5WiP110NOGP00VEBrv�SMOWN6ELOWONA11AC11FOURCOPIE51 pAOVISIONSOFLAW5AN00RDIIJANCESGOVERNINGTF115fYPE <br /> OF WORK WILL BE COMPLETED W1TH WHETHER SPECIFIED HERE� <br /> io�—oiocK—o� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF <br /> ANY OTHER STATE OR LOC�L LAW FEGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONTR�CT R OR AUTHORIZED �[�I DAiE <br /> X �'-/S�s> <br /> �� � <br /> PROJECIn00RE55 APPLICA'!i'CIiY9U:l ESSIICEN5EN0. <br /> /��O3 SE� �I - _ - � � � � <br /> PLUMBING MECIfANICAL <br /> NO. TVPE OF FI%TUflE PEE NO. TYPE OF EOUIPMENT FEE <br /> WATER C�OSET(TOILET) AIR COND.UNITS—H.P.EA. J___ <br /> BATHTUB REFRIGtRAiION UNITS—H.P. EA. <br /> LAVFTOA�I�VASH BASIN� BOILERS—N.P.EA. _ <br /> SHOWER GAS FIRED AC.UNITS—TONNAGE EA. <br /> KRCMENSINKdDISP. FORCEDAIRS�STEMS—B.T.U. MEA. <br /> DISIiWpSHER WALL HEATER3—B.T.U. M <br /> LAUNDRVTRAY UNITHEATcRS—B.T.U. A1 ___ <br /> CLOIHES K'�SNER BVAPORA7NE COOLERS _____ <br /> WATER HEATEF CLOTHES DPVERS _ ___ <br /> URINAL VENTILATION FAN __ _ <br /> �RINKING FOUNTAIN F7ANGE HOOD __ __ <br /> FIOOR DRAIN AIR HANDLING UNIT— C.F.M. _ ___ <br /> VACUUM BPEAKERS SiOVE _ _ <br /> ROOF DRAINS—i7AINLEAOERS M17ETAL FIf1EPLACE 8 CHIMNEY _ <br /> SINK�SERV'�E—BAR.ETC. _ _ 'NOODSTOVE/FIREPLACE NSERT <br /> --(a/-tL7`� � - --� — <br /> --— --f-- — — <br /> SUB TOTAL SU�TOTAL � Y' _ <br /> PERMIT S U _ PFRMIT 5 <br /> i�— ';OTAL FEE _ S _� � TOTAL FEE S r�� <br /> THIS PO�`TION TU BE GOMPLETED BY BUILf�ING DEPT. PERSONNEL <br /> fflpNf5Ef0�CA P[RRSEIB, 'N SIJE5EI9�CK PUNCHEG: NUMBER PI.ANCIIECNtEE <br /> F[E PEC[iPt NO <br /> USEZONE LOfIRE� ypCANfSRE <br /> FEES VALUATIOfl FEE <br /> DYES ONO -- <br /> tt�E01'CONS� OCGNf�NGYGfOUP �IlO.OFpWEL�INOUNIiS _ <br /> BUILOING f <br /> $IEE Of 9lOG ND Of S�OfilE9 ."Y OCG IOR� <br /> PLUMBING � __ <br /> AIECF.ANICFL � <br /> _� J <br /> FIRE SPRINKLERS REOUIRED ❑VES ❑NO <br /> OTMEF <br /> PENALTY <br /> aPPIICA�ION ACC Bv—TPLANSCIIEGNEO�Y APPR.FOR ISSUANGE BV <br /> :�TAL _�_ �J� �� <br /> —e� <br /> � <br />