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,��..,, �APPLICATION FCri+t <br /> everett <br /> CONPERMITTION e <br /> BUILDINO DEPT. TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 258•8745 � COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMB14p ❑ SION <br /> -J•� MAII�ODPE93 ��I21P p��E <br /> � �'�h� _.�D �.UI3 �ENrtC C�/E2Etf�TM J.�. 2le� <br /> � T/E��CT011pfE1}IO/N�EIRI MML�DpPES9 <br /> �VI7 TTRIfb�� CITY 21P PNONE <br /> �OENEM�L�C(O�NjTR��GTOq M�II�DDRE39 �/� .w..� /��,� <br /> ��V.1W �. .�V/� �� /'W�V�I Y 1 �A I� Cltt , Y/"�� ZIP� PIIONE LICENlE• <br /> MECN�NIGL CONTMCTpt L ��� ���� �.s� <br /> CITY 21P PHpIIE LICENlE• <br /> PLUMlINOCONTMCTOR MAILADDRE59 <br /> qry . 21P PNONE LICEM6E• <br /> CUSlOF WppK <br /> ❑ NEW ❑ ADDITION ❑ ALTEpATION � pEPA1R ❑ DEMOLITION ❑ WOpD3TOVE/FRPL.INSERT ❑ BUILDINO RELOCApON <br /> WLV ONOFNp11K�CO�TOFM�TEqI�L9PLUSL�SOR� <br /> �IO,mb� <br /> RI Wp K <br /> uaeaeuiioira � E L' <br /> I HEREBY CEpTIFY THAT 1 HAVE READ AND EXAMINED THIS AF <br /> LEOAIDE qqT10NOFPqppEq7y�bNOWNBELOWOR11TT11CNFWPCOPIE9� P��CATIONANDKNOWTHE3AMETOBETRUEANDCORRECLALL <br /> PROVIgION3 OF LAWS AND OpDINANCE3 OOVEqNINO THIS TYpE <br /> �or_a�xK�or OFWORKWILLBECOMPLETEDWITHWNETHEpgpECIFIEDMERE � <br /> IN OR NOT.THE ORANTINO OF A PERMIi OOES NOT PpESUME TO <br /> (iIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANYOiHERSTATEORLOCALLAWREOULATINOCON9TRUCTION � <br /> OR THE PERFORMANCE OF CONSTRUCTION. . <br /> 910NAi4PE OFCONT Op OR�UTHORIZED AOENT p�7p <br /> M�OJECtADDREI! �VPLIGN78CI� E69110EN9EN0. � � <br /> rwr�Uo ( �� <br /> NO. T'►E OF FIKTUIIE MECNANICAL <br /> FEE NO. TYPE OF EOUIPMENT Fft <br /> WATEp CIOSET TOILE AIN COND.UNITS-H.P.EA � <br /> e�n+rue <br /> UVATORY WASH BASINI NEFRIOERATION UNIT9-H.P,EA <br /> � 9HOWER 901LEHS-H.P.EA <br /> OA9 flRED AC.UNITS-TONNAOE EA � <br /> ( KITCHEN 81NK�D19P. FORCED AIR 9Y9TEM3-B.T.U. M EA <br /> DI8NWA9NEq - <br /> LAUNORV TRAY WALL HEATER9-&T.U. M � <br /> CIOTHE9 WASHER <br /> UNITHFA7Epg-g,T,U. M � <br /> WATER HE�TEp EVAPOMTIVE COOlER9 j - <br /> UNINAL CLOTHE9 DRVER3 ' ;' <br /> DqINKINO FOUNTAIN �ENTILATION FAN <br /> FLOOq DR�IN AANOE HOpO � � <br /> VACUUM BPEAKER9 AIR HANOLINO UNIT- C.F.M. �, <br /> 3TOVE ! <br /> NOOF OMIN9-MINLEADERS METAL FIREPUCE 8 CHIMNEY <br /> SINN 9ERVICE-BAR,ETC. � WppDSTOVE/FIREPLACE INSERT " <br /> N ! <br /> i: <br /> p. <br /> � <br /> t'.� <br /> IP <br /> sue ror�� ' <br /> PERMIT BUSTOTAL � ��� <br /> TOTAL FEE � VERMIT � i'� <br /> TOTA�fEE � ��, <br /> . THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL ''` <br /> RONTBE/BACK REARgEiB�CK SIOESEt&1CR •��� <br /> PL�NCHECkNUMBER OUNCHECkfEE D'- <br /> e•' <br /> SE SONE <br /> lOT AREA FEE PECEIPi N0. ;< ' <br /> VACANi 91TE �ti <br /> OYES ONO fEE� VALUIITION FE[ <br /> �PEOFCONST. p�CtIP�NC1'6ROUP NO.OFOWELlIN0UN1T9 ,�,�� <br /> !.: <br /> p•; <br /> 'LEOFlIOQ NO.OFSTONIES M�%.00C.t0�0 BULLDINO = L[' <br /> PLUMBINO :'i� <br /> :,q <br /> MECHANICAI �.!i: <br /> iRE SPRINKlER3 REOUIRED ❑VES ❑NO ��}� <br /> OTMER �''��. <br /> t;� <br /> 'PUC�TION�Cf).ev PEN�LTV ��'� <br /> PI.�NBCNECItED 9Y APPp.FOq 139UANCE BY <br /> rornt 'i�� <br /> ;r}f. <br /> .;�;�. <br /> ,;�', <br /> ;'. <br />