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i <br /> �APPLICATIQN F(;� <br /> �ry�ro'"° CON �Tf�UCTION eV� <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br /> OWNEP MRII R�DRE55 CITY ZiP PHONE <br /> �f r/��� c���7/�S� Ldi:y-L�"/2.� C� ';�',� j � -� <: ' U �1 �/ <br /> �RGNIIECTOFDE IGNER MAILAOORESS GITv ZiP PIIONE <br /> f�� ` '7 � � <br /> � <br /> G � ?��� L LI�P �iLt+i't' 4�.%j( _� J / � > <br /> GENEf'�LCONIRAC�OR MAILA�ODf E55 GITY ..iv PNONE LILENSE• <br /> IUP,�eorl �r', c J�<.�.h 1'fc';iuc 5 ?. -�//-J�-�3'='-<! ix�lz,�/ i'.SC?:/ :Y'7/3'��S'' ���LCZ'c'/'i'` <br /> MECN�NiCALCONTR�CTOfl MAILAODRE55 CITY 21P PHONE ��CENSE♦ <br /> PLUM8IHGCONTRAGTOR MFR��OFE55 GIiY ZIP PHONE 4f,EN5E• <br /> CLASS OF WORK z <br /> ❑ NEW C� ADDITION ❑ ALTERATION ` REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION O <br /> H <br /> WlW1�ONOF WORNICOSTOF MRTEPIA�S PLUS UBOPI ~ <br /> n <br /> � ���L� .� [�J <br /> oEsceiae won�/ �j � . /' <br /> �rv /�Y� /T'%/ I12:Y�n-.S /C ' . �1�. �i ���i,nr �.�'rb , �<: :C�;,L' -1�� ��. / � �., .�/. 'r: <br /> USEOie IlOING <br /> ��_ . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> I£ PLICATIONANCKNOWTHESAMETOBETRUEANDCORRECT.ALL y � <br /> LEG�LDESGRPTIONOFPpOPERiV�SHOWNBELOWORATTACNFOURGOPIESI pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK W4LL BF CON�PLETED WITH WHETHERSPECIFIED HERE• � � <br /> ior_e�ocK—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORI�iY TO VIOLATE OR CANCEL THE PaOVISIONS OK � <br /> ANYOTHEF STATEOR L9CAL LAW REGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE GF CONSTRUCTION. y <br /> SIGNAiURE OF CONiRnCiOR OR AUTHOR2EU AGENi OATE O <br /> x'i_k ,��> �;t�� ; y/.;�%'�-- � � <br /> PROJEGT�DDRE55 APCUCAHTSCIrvoUtiirvE55L�CEN5E��0 �Qy 7y-' <br /> 2 L/J �p�r L1�r"� — r, p�rT% (.t � C" H <br /> �-� <br /> PLUMBING MECHANICAL — � <br /> NO. TYPE OF FI%TUflE FEE NO. TYPE OF EOUIPMENT FEE � <br /> �- WAiERCLOSET�TOILE CO AIqCOND. UNITS—H.P.EA. "'1 <br /> - BATHTUB D F7EPRIGERATION 11NIT5—H.P. EA. __ <br /> LA�ATORY�WASH BASIN) 00 ODILERS—H.P.[A. , � N <br /> Z SHOWER OO GAS FIRED A C. UNITS—TONNAGE EA � <br /> KITCMEN SINK 8 DISP. DO FORCED AIR SYSTEMS—B.T.U. M EA. � � <br /> DISHWASMER WALI HEATERS—B.T.U. M N <br /> LAUNDRYTRAY UNI�MEATERS—B.T.U. M � <br /> _ CLOTHESWASMEF OD EVAPORATIVECOOLERS _ � � <br /> WATER MEATER OD CLOTHES DRYERS _ <br /> UFINAL VENiILATION FAN <br /> DNINK�NG FOUNTAIN F7ANGE HOOD � <br /> FLOOR DRAIN AIR HPNDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE �.y <br /> ROOF ORAINS—RAINLEADERS �+1[TAL FIFEPLACE 8 CHIMNEY � <br /> H <br /> SINK�SERVICE—BAR.ETC. WOODSTOVE/FIPEPLALEINSERI _ � <br /> H <br /> H <br /> n <br /> tn <br /> SUB TOTAL �� SUB TOTAL 5 <br /> PENMIT S PERMIT S <br /> TOTALFEE S O TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FflOHTSETB�CK AEAHSEtLACN SIOESEtBACN PLANG��ECKNl1M8ER PLFNCIIEGKFEE <br /> FEE R[CEIPI NO. <br /> USE20NE LO•AREA V�CANTSITE <br /> fEES VRLU�TION FEE <br /> OVES ONO <br /> 1YPEOFLONST. OCCUP�NCYGROUP NO.OFOWEL�RIGUNITS <br /> BUILDING S <br /> SIZE OF 9L0�. NO.OF SiOBiES MR%.pCC.LOAD <br /> PWId�ING <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ VES ❑ NO <br /> OTHER <br /> PENALTY <br /> APFUWLIONACCBY PL�NSCMECNEDBY APPq.FORI55OANGEB� <br /> TOTAL <br /> I <br />