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. PPLICATION FO►� everen <br /> clrrOr��r�� COhSTRU�TIt� N � <br /> everett PEI�MIT <br /> BUILDIIJG DEPARTMENT <br /> 259�8745 TO BE COMPLETEQ IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLU�VIBING ❑ SIGN <br /> OwNER MniI.qOD4E55 L�iV Z�v pNONE <br /> i��i1 /_-, Fi'Ci ��r �7_?�) .fai�srn9 � l/�'i7�CL `i'�':',C3 `�; ;- 7=)�j•=,- <br /> ♦RCIIIIECIORDESiGNEH M�IL�pOBE55 CIiY LP PMONE <br /> GENEPA��OMR�CtOR MnILA0pFE55 �IIY TIP vI�ONE IICEirSE• <br /> MECIIANt�,1�[ONiRILtOq MAIL��ORESS CIiY 21P PIIJNE �ICE115E• <br /> FW�.IBiNGCONiRA�iOR NPItrDORE55 CIIY ZIP pIIONE �I[E1lSE• <br /> CU55�F WORN �- �( <br /> ❑ NEW ❑ ADDI110N ❑ ALTCRATION ❑ q'cPAIR ❑ DFMOLI710N {Si WOODSTOVE/FRPL.INSEflT ❑ BUIL�ING RGLOCATION <br /> W 1U�110N OF WORN�COSf OF MAIERIALS PLUS LABORI � <br /> �-�C'��I.CD <br /> JCSCRiBE ORN / <br /> ��.,,�C '/J��/dlc! (�9.57�-L(� . L�7t,' <br /> use ov ow�ou+a . <br /> I HEREBY CERTIFY THAT I HAVE RFAD AND EXAMINED i HIS l�P� <br /> PLICATION AND KNOW THE SAME T�J BE TRUE ANDCORRECT.�lL <br /> IEG�LDESCRIPiIONOFPROPERfT�SHOWNBELpWOPATTRCNFUVRCOP1E51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL EIE COMPLETED WITH WHETHER SPEGIFIED HERE- <br /> io�_e�uc�—o� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRFSUME TG <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REVULATING CONSTRUCTION <br /> OR THE PEFlFOflMANCE OF CONSTRUCTION. <br /> SIGNATURE OF GONIRAC�ON OR AU7110RIZCD AGENi DAtE <br /> X/ t.-!U ..�^ � ij�i/ �-� %�J;�'�� <br /> ❑FOJ[LT AOORE55 pPP�ICANiS CIIY BU`_INE SS IICENSE HO � <br /> :-�J�o Tuckso�, C- c�ee�et/ i'��:�� <br /> PLUMUING MECHANICAL <br /> NO. TYPE OF FI%TIIRE _ FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILEp AIR COND.UNITS—H.P.EA. <br /> BATHTUB qEFq�GERATION 11NIiS—H.P.EA. <br /> IAVhTOFY I�VASH B�SIW BOILERS—H.P. EA. <br /> $NOWER GA$FlREU AC.UNITS—TONNAGE E�. <br /> HITCHEN SINK 8�lf�. FORCED AIR SYSTEMS—B.T.0 M EA <br /> DISHWASHER WALLHEATEPS—d.T.U. M <br /> LAUN�RYTR4V UNITHEFTERS—B.T.U. M <br /> CLOTHES WASHEH EVAPORATIVE COOLERS <br /> WATER HEATER CLOTNES�FVEPS <br /> URINO.L VENTILAiION FAN <br /> DRWKINu POUNTAIN RqNGE HOOD <br /> FlOOR ORAIN AIR HAIlDLING UNIT— GF.M. <br /> VACUUM BREAKERS STOVE <br /> NOOF DRAINS—RAINLEADER$ METAL FIREPLACE d CHIMNEY <br /> SINK�SERVICE—BAR.ETC �I WOOOSTOVE/FIREPLACEINSERT <br /> SUBTOTAL SUBTO7AL S <br /> PERMIT 3 PEqM1T S <br /> _ TOTALFEE 5 TOTALfEE S <br /> THIS PORTION TO BE COMPLETED B';' BUILDING DEPT. I'ERSONNEL <br /> fq�NtSEtpqCN RE/BSEIBACK $IpE5EI8AGK �LANCHEGKN pER nn/ PUNCNF.CHL[E <br /> C�.� / 7`//�5 FEE RECEinINp <br /> J � �U! <br /> ❑SEIONE LOiRRE� yACRNi51iE <br /> OVES OHp FF.ES �ALURTION fEE <br /> n'PEOFCJN51. OCCUPpNCYGROUP NO.OFDWELLINGUN115 <br /> Bl11LDING S <br /> SIZE Of OLDO NO Of SiOAIES MAK OCC.LOAD <br /> PLUMBIN(3 <br /> MECHRNICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑NO -- <br /> O1HEF <br /> PENAL7V <br /> <PPUCAIION RCC BY PLANSGNECNED BY 4PPq FOR ISSIIANGE BY - <br /> 1,n TOTAL <br /> `"vr\ 1'V` -- — - <br /> i <br />