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�''•_'�'PLICATION FO(��:�-' � <br /> '°.E".,°'"° CO N STRlJ CTI O N �e <br /> 'cm ov <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> P� MnILAJORESS CITY ZiP PHONE <br /> I!o��e o �i�fus /s�a h�;,� ,Ba� 6����f tJ�4- 99zoi �.�i -ses-a <br /> �P NITEC�ORDESIONEf1 MRILRDpRE55 Cltt ZiP PIIONE <br /> DENERAICONiN�CIOB M�IUODRESS CitY ZiP PMONE �j17O tICENSE• <br /> /i/o2 N�f6o�i��Q f..�Cv.1 /�C 91n 8 Oc_d„s,iv 4'> R/ nI'/�W//ri« u/i�a �S3-�J'2 <br /> MECN�NICALGONiR�CiOq MAILAOORE55 `�V � 21P � PNONE �^ LICENSE• <br /> b/O-.�N �.SA/•S,—`1���'�. <br /> PLUMBINOCONiP�CIOR M ADOFE55 GIIY 21P PIIONE �IGENSE• <br /> 1 <br /> CUSS OF WORN <br /> ❑ NEW ❑ ADDI710N ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/ffiPL.INSERT ❑ BUILDING RCLO�ATION <br /> W LU�TION OF WORN�COST OF�M—AIERULS PLUS LABOPI <br /> CJ/ OO b <br /> UESCR� � RK /, /� <br /> t�s �.C. CfX�Jl7 �Y'.rY�k•ea p'- /�v.fnJ-cG J✓(.�c.(� r7ce�.fi /�o /h�P G�C� <br /> use or suamnc <br /> ��� i HEREBY CER7IFY THAT I HAVE READ AND EXAMINED 7HIS AP- <br /> PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br /> LEOR�OESGRIPTIONOFPBOPENTY�SNOWNBELOWOf1ATTACHFOORCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> 'L� F 30 �S'U v� �V OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE- <br /> �or—eioc�loF_ IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> , GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. � <br /> SI4NATUR -CONTflACTOROflAUT110R12EDACENT DATE <br /> X ��1�6 ' <br /> _t�, E ' 38S-Z9fl—OZ � oaoS"' _ �� <br /> GROJEGT�OORE59 APP iCAN CITYBUSINESSULENSENO. <br /> � �08 �v� � <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATERCLOSET TOILE AIRCOND.IINITS-H.P.EA <br /> BATNTUP REFRIOERATION UNITS-H.P.EA � <br /> LAVPTORY�WASH BASIN BOILERS-H.P.EP. ' <br /> ' SHOWER �AS FIRED A�.UNITS-TONNAGE EA <br /> NITCHEN SINK d DISP. FORCED AIR SYSTEMS-B.T.U. M EA. � <br /> DISHWASHER WAILHEAiERS-B.T.U. M <br /> LAUNDflYTRAY UNITHEATERS-B.T.U. M <br /> � CLOTHES WASHEF EVAPOHATIVE COOLERS � <br /> WATER HEFTER CLOTNES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKINO FOUNTAIN RANGE HOOD <br /> � FLOOR DFAIN AIR IiANOLING UNIT- QF.M. i <br /> _ VACUl1M BREAKERS STOVE � <br /> ROOF ORAINS-RAINLEADERS METAL FIPEPLACE� CHIMNEV <br /> SINK SERVICE-BAF ETC. WOODSTOVE/FIREPLACE INSERT � <br /> _ � <br /> � <br /> SUB TOTAL SUBTOTAL S <br /> PERMIT S � PERMIT 3 <br /> TOTALFEE S TOTALFEE f <br /> i 7HIS PORTION TO BE COMPLETED BY BUILDIN� DEPT. PERSONNEL <br /> FPONi SEIB�GN RE�R SETB�CN SIOE SETBACe PL�N CNECN 1fUMBEf1 PLeN CNECK fEE <br /> � fEE AECEIPi NO <br /> USE20NE 107AREA y�L�NiSItE <br /> � OYES pN0 FEES Vl�LU�TION FEE <br /> TYPEOFGON4t. OCCUPANCYGROUP NO.OFOWELLINOUNItS <br /> , BUILOINO S <br /> SRE OP BIOQ NOAf S10PIE9 M�k OGC.LO�D <br /> P�UMBIN� <br /> MELNqNICA� <br /> FIRE SPRINKLERS REOJIRED O VES ❑ NO <br /> OTHEII <br /> PENRLTY <br /> APPLICATION�GC.9Y PLAN9 CNEGNED BY �PPR.FOfi 15511�NGE BY <br /> TOTAL <br />