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� <br /> _ - APPLICATION FO� � � � � � � � <br /> '"'E"ro"'° CONSTRUCTION ��AR �s �sa5 °�°�°„ <br /> Qtt�F <br /> evere�:�� PERMIT ._�.............................................._..... <br /> CITY OF EVERETT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT P�t:le Werk� Dep;, <br /> BUILDING DEFT. <br /> 259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ,� SIGN <br /> � OWNER MML��OR[SS L dTV 21P PMONE <br /> •R�I�I�NSiGN� � �1�0 • Z��Z S�C W�,�� /��. EVErEfI� IIP Z„.S�- �/3SS <br /> GENENALGONiNAC10P M�ILAODRE55 Cltt 2iP PNONE UCENSE• <br /> S+5 $iGN CA 13190 STOpE �cJE N• SuH-� u.A Ari33 3�d•es�z�1��`s/•w <br /> MEGNANiGL�ONiR�CTOB M�IL�ODRE55 '� CIiY �� Z„ „ PMO/E, LICENSE• <br /> E/e�e.r�� �� I� � � �SSKC'�3o.�eN <br /> PWMBMfiGONiPACTOR MARAODRE55 CITY Z�P PMONE IIGENSE• <br /> CU55 OF WORN <br /> � NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOIITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LU�TION OF WONN�COSIOF MRT[RI�L51'WS UOORI <br /> �.AOd oc <br /> o�scnmewoun <br /> s o :ca —,r � .N d . _ <br /> USE OF BWIDING � <br /> ' I HEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS AP• � <br /> t i IO/V PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL m <br /> LW�LOFSCRIVTIONOFPpOPCR1YI5��OWNB[LOWOR�RACIIFOURCOPIE51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE .. <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �or_e�ocK—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF � T <br /> ANY OTHE R STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. � N = <br /> SIGNATURE UF CONTP�CTOP OR AUTHORI2ED�GENT D�TE O fT1 <br /> X 3_�.� r"� <br /> � � <br /> PROJEGT�O�N[55 APPLICANTSLILYBl15ME5 LiCENSENO. 03 <br /> m <br /> -i z <br /> x -i <br /> m <br /> PLUMBIN6 MECHANICl1l ,p Z <br /> NO. TYPE OF FI%TUNE FEE NO. TVPE OF EOUIPMENT FEE n � <br /> WATER CLOS[T�TOILET) AIF CONO.UNITS-H.P.EA. H M <br /> BATMTl1B REFRIGERA710N UNITS-M.P.EA --I ln <br /> IAV�TORY�WA511 BASIW �OILERS-HP.EA. � <br /> T <br /> SHOWER GAS FIRE�A.0 UNITS�-TONNAGE EA � y <br /> T <br /> KITCNEN SINK 8 DISP. FORCEU AIR SVSTEMS-8 T U. M EA. �m <br /> DISMWASNER WALLMEATEFS-B.T.U. M = <br /> m � <br /> LAUNDRVTRAV UNITHEATERS-BT.0 M � N <br /> CLOTH[5 WASHER EVAPORATIVECOOLEHS O r <br /> WAtER MEATER CLOTHESDRYERS �N <br /> URINAL VENTILATION FAN m N <br /> DRINKING FOl1NTAIN RANGE HOOD � r <br /> FLOOR DFAIN AIR IIANOLING UNIT- C.F.M. ' m <br /> a <br /> VACUUM BREAKERS STOVE A <br /> flOOF DRAINS-RAINLEADERS METAL FIREPLACE 6 CHIMNEY = <br /> SINK�SEFVICE-BAR.ETC. WOOOSTOVE/FIREPLACEINSERT z <br /> �--1 <br /> _ <br /> � �" <br /> _ � <br /> 2 <br /> SUBTOTAL SUBTOTAL 3 � <br /> PERMIT f PERMIT S � .+ <br /> _ TOTALFEE S 1'OTALFEE S i m <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FqONTSETB�CN NGRSEfOACR SIOESEi�AGN PUNCNECRNUMDEP PL�NCNECNFEE <br /> FEE NECEIPT NO. <br /> USFZONG �a�/�I� VACANiSrtE <br /> FEES V�LU�TION FEE <br /> DY[S ONO <br /> LYPGOFCONSL OCGUI'ANCYGf10UP NDOFDW[ILINGUNIiS _ <br /> Ol1ILDING 3 <br /> Sll[OF flLDG NO Of S10R:!t5 MAN OCQ LOAD <br /> PLUNBING <br /> MEGIIANICAI � <br /> FIRE SPRINKL[RS R[OUI{lED O VES ❑ NO <br /> oTMER <br /> � NENPLTY ' <br /> APPLICPIIONALCOY PlAN5G1ECKE0BY APPRfORISSUANC60V — <br /> TOTAL I <br /> ,o. <br />