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���?PLICATION FOk��-'' <br /> `�.E'.,°`"� CC�NSTRUCTION everetl <br /> an ov <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COM8INATION ❑ BUILDING ❑ MECHAN�CAL ❑ PLUMBING ❑SIGN <br /> OWNEF MAllR0�RE59 �Irv ZiP PIIONE <br /> E�w�N Q. PE�s� i s�z Elv YT Ev�P�r �'ezo� a r8-z�6u�N� ZrB-y��(w) <br /> •RCHITECTOR ESIGNEN MNIAb�RE55 CIfV 21P PIIONE <br /> GENERA�GONiP�GTOR M�IL��DRESS �Irv ZiP PI�ONE L�CENSE• <br /> S¢ /i <br /> MECHANIWIGONTMLiOq MAIL/O�BE55 CIIY ZiP PIIONE �iCENSE• <br /> PIUMBiNOCONtR�GtOR MAII�UUPE59 GiIY TiP PIIONE LiCENSE♦ <br /> Cl�ea�•:.UNN <br /> ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEf7T ❑ BUILDING REIOCAlION <br /> W LU�TIOH OF WORN�COST OF IAniENIRLS FLUS I�BORI <br /> �(SOao <br /> oescRiee wonK ` � � L �/J� � <br /> (p00 S f nact��bn (� [ G1/Wt�,. � �G Q..�:.� Ct-cc- <br /> us=_oFewimnc <br /> I HEREBY CERTIFY TH I HAVE REA� AND EXAMINED THIS AP- <br /> L�✓�^q SpR�e PLICATIONANDKNOWTHEgqMETOBETRUEANDCORRECT.ALL <br /> LE��LD SCRIPi NOFPPOPEliTY� HOWNOEIOWORAITRLHFOURCOPIE I <br /> y€ , � � PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHI3TYPE <br /> �o��";eoc��or L NS �-� � Dot GFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> IN OR NO.:THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LO L LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANC F CONSTRUCTION. <br /> SIGNATURE F ONTI7ACT A� iH0(iIZEU�GENT DATE <br /> X � <br /> n 9-l0 -86 <br /> PA^".GIA�ORESS qPPLI gCIfY0U51N855L�CEN5EN0 <br /> So z Na Y T LVE,Q�7J' c(lA• 98�0/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIF CONO.UNITS—H.P.EA. <br /> BATHTUB REFRIGERqTION UNIiS—H.P.EA. <br /> LAVATORY(WASH BASIN� BOILERS—H.P.EA. <br /> _ SHUWER GAS FIRED AC.UNITS—TONNAGE EA <br /> I NITCHEN SINK d OISP. FORCED AIR SYSTEMS-6.T.U. M EA. <br /> OISHWqSHER WALLNEATEHS—B.T.U. M <br /> LAUNDPV TRAV UNIT HEATERS—B.T.U. M <br /> CLOTHES WASNER EVAPOHATIVECOOLERS <br /> WATER HEATER CLOTHES DRVERS <br /> URINAL VENTILATION FAN <br /> DRINHING FOUNTAIN RANCE HOOD <br /> FIOOR�PAIN AIR HA40�IN6 UNIT— C.F.M. <br /> VACUUM BREAKERS TOVE <br /> FOOF DRAINS—NAINLEADERS METAL FIREPLACE`6 CMIMNEY <br /> SINN SERVICE—BAR.ETC. WOODSTOVE/FIREPLACE INSFRT <br /> SUB TOTAL SUBTOTAL 3 <br /> PERMIT S PERMIT f <br /> TOTpLFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fNONiSEiBRLM p�R5E1BACN SIpESETBAGN PLAHGHECK UMBER P�L/R;NCIIECKFEE <br /> � ,�.�� � � C.I. � FEE /(�.�J� i�ECEIPt NO. �'O'D�/� <br /> Q 10 �/�J Q a Y <br /> U9E 20NE LOi�liE� y�CANT 5{iE <br /> OYES r�NO FEES V�LU�TION FEE <br /> TYPEOF�ONST. OGGUPRNCYGRO P NO.OFD\VEllINOUNIiS �(( l i� �� 2 1 L� �p� I� SO <br /> V� � � � I BUIL�ING 5���. �// !�� O� <br /> SRE OF BLDO NO.Oi STOPiES MAK OCQ LO�D <br /> �Sr �n I PLl1MBIN6 �O <br /> MECHqNICAL <br /> FIpE SPRINKLERS FEOUIRED ❑ VES ❑ NO <br /> OTNER <br /> PENAITY <br /> APPUC�110NnCC.BY PUN9CHECKEUBY �GFRfONI55U�NLEBY � <br /> ,�,1� � S� L . G ror.� S'3 .� o <br />