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,�.Ew,o.»� �F�.PPLICATION FO,� ' ���,�„ <br /> ��ry�F C�ONSTRUCTION 0 <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDIN6 ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> aM,HEq M�iLA00NE99 CITV ZIP PHDNE <br /> �� .-✓F' !� ,,la,S�i�So�l /S'�t� Ln„�,�,a.�rJ �dc�?�7-i <br /> ♦RCHb2CTORDE910Nr_q M�IL�OORE9B Cltt ZIP PHONE <br /> 0'NER�LCONiRACTOR /M�IL�OOPE99 � CItV �/ y21P PHONE LICENSE• <br /> MELH�i�ICOII��COH ��i �(' J��OOR� �QV S ��P/�� /��� �0..�-Y�76 JnaeN5Eiv7�'� <br /> PLUMBM6CONtR�CtOR MAILAF9PE59 CITV 21F P110NE IICENSE• <br /> CUSS OF WORK �./ <br /> ❑ NEW ❑ ADOITION ❑ ALTERATION lD-REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSER7 Ci BUILDINO F7ELOCATION <br /> W�W TION OF WOAK�COST OF MAL?WRLS PLUS L�90Po <br /> / .if�J <br /> �/' �� — <br /> OESCRIBE WORN <br /> �E�.cl l�.vA[ S�:�i� ?� C 7 .r/G S <br /> use or fe�uaoiHo � I HEREBY CERTIFY THAT I HAVE READ ACIJ EXAMINEO THIS AP- <br /> /7L"S/���Lr' � PLICATIONANDKNOWTHESAMETOBETRUEANDCOfiRF.CT.ALL <br /> LEO LOEBCRIPTIONOFPROVEPTY�9HOWNBELOWORATT�CMFOUHCOPIE91 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> � )ky OF WORK WILL BE•COMPLETED WITH WHETHEq SPECIFIED HERE• <br /> �or�e�oc�—�r— �T��^-� '� ^ �� IN OR NOT.THE GRANTING OF A PERAiIT DOES NOT PRESUME TO <br /> �-0b GIVE AUTHORIT'Y TO VIOLA7E OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION <br /> . OR THE PERFORMANCE OF CONSTRUCTION. <br /> SI�NATUREOFCONTFACTORORAUTNORIZEDAGENi �ATE <br /> X z�r,cuu�U�C.� '�.�.- <br /> PPOJECT��OORESS APPLILANTS CITY PUSINE55 LICENSE NO. <br /> -��--�`/-�� �1�Z/ /'�-�� <br /> PLUMBiNf. MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. � TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) AIR COND.UNITS-H.P.EA <br /> E:ITHTUB REF.iIGERATION UNITS-H.P.EP. <br /> L/��ATORV�WASH BASINI _ BOILERS-H.P.EA. ___ <br /> SHOWER OAS FIREO AC.UNIiS-iONNA6E E0. <br /> KITCHEIJ SINK 6 DISP. FOFCED AIR SVSTEMS-B.T.U. M EA. _ <br /> DISHWASHEH WALIHEATERS-B.T.U. M <br /> LAUNGRVTRFV UNITHEATERS-B.T.U. M <br /> CLOTHES WASFIER EVAPORATIVE COOLERS _ <br /> WATER H[ATER CLOTHES DRVERS_ <br /> UPINAL VENTILATION FAN <br /> DRINKING FOUN7AIN RANGE HOOD <br /> FLOOR DPAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM flREAKcqg STOVE — <br /> ROOF DRAINS-RAINLEADER3 METAL FIREPLACE d CIIIMNEY <br /> SINK(SERVIGE-BFfl,ETC.) WOODSiOVE/FIREPLACE INSERT <br /> SUB TOTAI_ SUB TOTRL S <br /> PEflMIT 3 PEflM1T S <br /> TOTALFEE f TOTALFEE E <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FpONi5E1BRCK PERRSEIB/CK SIOESETBACK PLRNCHECKNUMOEH PIRNCMECNiEE <br /> FEE RECEIPT NO. <br /> USE20NE LOT�RE� yqCANT5ITE V�LUATION �EE <br /> FEES <br /> OYES aN0 <br /> rvPEOFCONST. OGCUMNCYGFOUP NOAFOWELLINGUNITS _ <br /> BUILDINO S <br /> SRE OF BLOG NO.OF SiORIES • MAX OCG LOAO <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑Y�S ❑ NO <br /> OTHEH <br /> PENFLTY <br /> RPPLICAIIOHFLC.BY PLANSCNECNEOBY RPPR.FORISSU�NGEBY - <br /> TOTAL <br />