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� r�PPLICATION f0.: ���,�„ <br /> '".E"'°`"" CONSTRUCTI�D►N e <br /> ��r�F <br /> everett PERMIT <br /> F3UILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COM8INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> / /I� L \ S� � O �.l,�L�CURESS ^�I��lY 21/' ! U' [ 1/c�lV( L� �� `\ <br /> 'l5 /�D� .!> _ <br /> �GNIIEGtOflDE51GNER MAIL�DOPE55 ��n' =�P ��, ,[—^ � /7 a D <br /> P J L, (/ <br /> GENERRLGOf1JpA�TOFq � MAILAppRE55 —� CItV ZIP PHONE LICEIISE• <br /> .S e ( <br /> MECN�NIG0.CONIP�CiOq M�ILADDNE55 GI1Y ZiP PHON[ LiCENSE• <br /> PLUMBINOCONiR�CTOB M�ILFDOHESS GIIY ZIP PI10NE 4GENSE� <br /> CUSS OF WORN <br /> ❑ NEN' ❑ ADOITION ❑ ALTERATION �i tiEPAIR ❑ DEMOLITiON ❑ WOCD3TOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V �iIONOLN�pJNN/IC^O5T0iMR�ERiRL5PLU5LFBOPI <br /> �O'� V O I C/+ <br /> OE RiBE WONN D 0 ^ � [�O f��e� �_ l ^���� � <br /> T l �] l \Y �/ / <br /> 4 V / \.! (1 /� <br /> USE UILOINO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOK'THE SAMETO BETRUEANDCORRECT.ALL <br /> tEG�LDESCRI ONOFPflO ERLYISNOWNBELOWONATT�GNFOtIRGOPIES7 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- � <br /> LOL—BLOCIL—OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO � <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW fiEGULATING CONSTRUCTION <br /> "' OR THE PERFORMANCE OF CONSTRUCTION. <br /> -- SIGNAT REOFCONTpACTOROR.Ol17H0 AGENT DATE ( <br /> ,�02�� /'r-� i l/2,�' d-cl ! <br /> NOJECT�DDNESS APPUCRNiSCITYBU51NES54CEN EI � <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FI%TURE FEE NO. TYFE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILE7) A�R COSID.UNIiS-H.P.EA. _ <br /> BATHTl18 REFHIGERATION UNIiS-H.P.EA. <br /> LAVATORY�WASH BASIN) BOILERS-N.P.EA. _ <br /> SHOWER GAS FIFEO AC.UNITS-TONNAGE EA <br /> HtTCHEN SINKB�ISP. FORCEO AIR SYSTEMS-B.T.U. M EA. <br /> DISHViASHER WA.LL HEATEflS-B.T.U. M <br /> LAUNORVTRAV UNITHEATERS-B.T.U. M � <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEA7[R CLOTHES�RVERS <br /> URINAL VENTILATION FAN <br /> ORINKING FOUNTAIN FAN�E HOOD _ <br /> FLOOR DRAIN AIR NANDL�NG UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINLEADEHS METAL FIREPIACE 8 CHIMNEY <br /> SINK�SERVICE-BAF.ETC. WOODSTOVE/FIREPLACE INSERT __ _ � <br /> SUB70TAL SUBTOTAL S <br /> PEHMIT S PENMIT S _ <br /> TOTALFEE ! TOTAIFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL � <br /> iHONISEiB�CR �E�RSEIBACN SIDESETBACK ALANGNECKNUMBER PLRNCHECNfEE j` <br /> �. 6 <br /> fEE �ECEIPiNO <br /> USE20NE LOTAlIE� y��ANlSIIE <br /> FEES VALt1AT�ON FEE j <br /> OYLS ONO � <br /> TYPEOff,qNST. OCCUPANCVGROUP NO.CFOWELLINGUNIiS <br /> 6WLDING S � <br /> SIZE OF BlDO. NO.OF SiORIES MA%OCG LOAD F <br /> 1 <br /> PWMBING [ <br /> f <br /> M1IECHANICAL i <br /> FIRE SPRIN'<LERS RECUIRED ❑1'ES ❑ NO �^ <br /> OTNEfl F <br /> � <br /> PENhLiY _ � <br /> APPLIG dOH RCC.BY PUNS CHCCKEO EY APPR FOR ISSURNCE BY — <br /> TOTAL <br /> j <br />