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� <br /> ' .: .PP' �.ICATI�ON FO ..' �,�.��, <br /> NeF�erpreen CO N ST R U CT 1 O N F"„a <br /> utr oF <br /> everett PERIv11T <br /> BUILDIIdG DEPAFTMEN�f <br /> p,g.p�q5 TO BE COMPLETED IIV INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �] PLUMIIING ❑ SIGN <br /> u.,,,�w� innaeom�Ess cirr zir �v�ionE <br /> �'- - � �� 3yol �o�v, b���� F�,e,-e�� �` <br /> i i1EC10f1UE5�GNER MRI�RODIIESS CIfY LV 01L <br /> IcUUlG01lIRAGtOfi � / AI�ILAOpR[55 GIlV ZIP PPONE IICENSE• <br /> ^) �UY'�tn5 ��'') SirCIC� n �• <br /> ���.nuruuirorv+nneron u�a�oonEss enr zir r�wr�E �euse <br /> f'UIMOIN4GONIRACtOq MAILADDPESS CrtY ZIP PI�OrvE LiC[��SE� <br /> =1' �i1 /l/� (c' �� U�vIP�//V"c 292^.,—�; Iver CrP�=� Dr�, ��o�tie(I ��S6iZ 3:37��>i7 <br /> cuss or wone 7�+/J/(/f••/y-/i p• <br /> � Ntyy ❑ ADDITION I�ALTERAiION ❑ REPAIR ❑ OEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATIOPI <br /> yplV���UN OG WORN�CO51 0f A�R�LRIALS PLUS�POOfii <br /> U[SCNOEWO�N <br /> use or owion+c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> PLICATION AND KNOW ThIE SAME TO BE TRUE AND CORRECT.�LL <br /> l[GAL�ESCNPIIONOFPROPEf1IY1$IIOWN�ELOWOFAIIRCflFOUfiGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHI57YPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �o�--u�ocK—ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> ' SIGNAIUREOF ONTflACTORORAUTHORIZ[��GENi D4IE <br /> X y,c�� �ti�.d,L� <br /> PFOJECt RDDRE55 /PPLICANTS GILY�USINE55 UGENSE NO. <br /> 3y-0 (o - G� ni ��A2 / �vc���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUf1E FEE_ NO. fYPE OF EOUIPMENT FEE <br /> / WATEBCLOSET�TOILEA AIRCOND. UNITS_H.P.EA. ___ <br /> BA7HTU8 REFRIGERRTION UNITS—H.P. EA. _ _ _ <br /> I LAVATORYIWASti B�SIN� OOILERS--H.P.EA. _ _ <br /> SNOWEfi Gn�FIRED AC. UNITS—TONNAGE EA __ <br /> NITCHEN SINK 8 DISP. FORCE�AIR SVSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS-9.T.U. M <br /> I A111�ftt1Y If1�Y .. UNIT HFATERS—A.T U td . <br /> . . . . . _ _._ __""_'"_'_—__ _'.....-._.�._. ..._ . - <br /> CLOlNES WASHER EVAPOPAIIVG COULGHS _—_ <br /> WFTER HEA7ER CLOTHES DRYERS _ <br /> URINAL VENTILATION FAN __ <br /> DPINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNR— GF.M. __ __ <br /> VACUUh1BREAKERS STOVE <br /> ROOF DFAINS—A�INLEADEi75 METAL FIREPLACE 6 CHIMNEY __ <br /> SINK�SERVICE—BAF.ETC.) WOODSTOVE/F REPLACE INSERT <br /> cJ u�,� �3 d-� <br /> SUB TOTAL SUB TOTAL S I�I __ <br /> PERMIT 5 PERMIT S __ <br /> TOTAL FEE S TOTAL FEE S �— <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONISEtpACR R[O,RSEt�ACR SIDESEtOAGK PLAHCHECNNUMBER PIr1NCHLCNFEE � <br /> fEE B[CEIPt NO. <br /> USE ZUNE �Ot RREA VpCANt SITE FEES YAIUATION FEE <br /> OYES ONO <br /> TYPE 0�LON51 OCCUPFNCY Gf1011P NOAF DWELLINO UNI75 ___ <br /> EUILOING s <br /> size or o�oo. r+o or s�onies MAX.OGQ LO/U 5 <br /> PLUMBING �V <br /> MECHANIC�L 3 <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br /> OTHER <br /> PEN�LTV <br /> APPLIC�IION ACC 9V PL�NSCII[CNE�9Y APPR FOR ISSIIANLE BY — � <br /> TOT�I <br />