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!ne£wrqreen A�PLfCATION FOR�� ���fe„ <br /> ��TM�F CONSTRUCTIG�N 0 <br /> everett PE RM I7 <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUIL�ING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> O'NNER 1AAILADDFESS CITY ),IP PIIONE <br /> 1 <br /> �tiel7 " v I_' �oF,-i 2t-,OI 'PCY.Soi� iJere `i���.'� �47 - /�O�s _ <br /> ♦RLHIIECTOR�ESiGNER M0.1LAO�RE55 CIiY ZIP PMONE <br /> G6NERnLCCNTPnCIOR IAAILRpORES:. CIIY 21P Frt�NE LICENSE� <br /> MEG11nNiCRLCONTPAC105 MAILPOUflE55 CILV ZIP PII)Nf UCENSE• <br /> PtUM61NGCONiPnGTOH lAAILApDPESS Cliv 21P 1'NONE LICEhSE• <br /> LLASSOF WOflN <br /> � NEW ❑ ADDI7IGN ❑ AL7ERATION ❑ REPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDI��G RELOCF.TION <br /> :'ALURtION OF WORK�LOSi OF IAAtERIALS PLUS LR�ORI <br /> -�_ �Jo pO — <br /> �E,��r�v,oAK <br /> /�I1CL/) ��/tk!-1�' J Uf�N. �o Olf �RLiJ�f��� <br /> us�or ow�oiHc <br /> I HEREBY CER7IFY THAT I HAVF, fiEAD AND EXAMINED TIiIS AP• <br /> PLICATION AP1D KNGW THE SAN.E TG BETRUEANDCORRECT.ALl <br /> LEG4LOESCHIPiIONOFPPOPERtV�5110WN0[LCW9RAi1AGMFOIIRCOPIES� pqOVISIONGOFLA�VSANDORDINANCESGOVERNINGTNISTYPE <br /> ��;�3�•.j9 11 p-C� � � � OF WORK WILL BECOM11PLETED WiTH WHETHER SPECIFIED HERE- <br /> ior�_a�ocK�oF IN OR NOT.Th1E GRAiJTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHOFiITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LQCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTIGN. <br /> $IGNATURE Of CONTqACTOR OR AUTNORIZED AGENT DATE <br /> X �� lmr���– �T�'—��� �� <br /> PPOJECiA�DPESS APPLIGANTSCILYB JINESSLICENSENO.� I ' <br /> �6G � ?'RCKSUN i=,;.:.e11 ��n sa�3 _ <br /> PLUMBING MECHANICAI <br /> NO. TVPE OF FIXfUflE FEE NO. TYPE OF EOUIPMENT _ FEE� <br /> WFiER CLOSET(TOILET� AIR COND.UNITS—H.P.E0. <br /> —) — <br /> BAiHiUB REFRIGERATION UNITS—H.P.EA. <br /> LAVATORY(WASH BASIN� BOILERS—H.P.EA. <br /> SHGWER GAS FIRED AC.UNITS—TONNAGE EA <br /> NITCHEN SINK L DISP. FORCED AIR SVSTEMS—B.T.U. M EA. <br /> �ISHWASHER WALLHF.ATERS—B.T.U. M <br /> LAUNDflVTRAV UNIiHEATERS—B.T.U. M <br /> CLOTHES lV/�SHER GVAPORA?IVE COOLERS <br /> WAiER HEATER CLOTHES DRVERS <br /> URINAL VENTIIAiION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE 8 CHIMNEV _ <br /> SINK SERVICE—BAR,CTC. WOODSTOVE/FIREPLACE INSERT , <br /> S�BTOTAL SUBTOTAL S <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE S TOTALFEE 5 <br /> THIS PORTION TO BE CGMPLETED B`.' BUILDING DEPT. PERSONNEL <br /> FROnI5E1pFCN REARSEiBAGH SIOESET04GK PIANCHECNNp1.IpEfl PLANCHECK(EE <br /> �O� � �r �J l�' QVY FEE ,�� Rf.�i!'iNlO�� <br /> OSE ZC E LOi AREA �ja �J <br /> �—� VACANTSrtE FEES VALUATION FEE <br /> pYES ONO <br /> TVPECFCONST. OCGUPANCYGROUP ND.OFOW[LLINGUNIfS <br /> V^ � 1✓1 ��A BUILDING s7�pp,� jyS � <br /> SIZE OF 3LOG NO OF Si0R1E5 MF%.00C.LOAD <br /> 7rjO S�7? I Nf� PLUMBING <br /> � MEGMANICAL <br /> FIRE SPRINKLEf'.S REOUIRED ❑ YES L�]'NO <br /> OTHER <br /> PENALIY <br /> APPLIGP110N�CC.OY PLANSCHFGNEOOV PP�P.FLRISSUANCEBY — <br /> TOTAL � <br /> S�� }�t,ll?'?] � •� �S� �� �JGI� O�-/ /"G.O(� <br /> -- c�l�C���t�' , <br />