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`��=APPLICATION F(��t ���,�n <br /> '"'E"'°'"" CONSTRUCTION e <br /> cin or <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259-8745 ❑ COMBINATION ❑ BUILDINa ❑ MECHANICAL ❑ PLUMBING ❑ 31(iN <br /> OWNER IA�ILAOUPESS Cltt Zli PNONE <br /> J I.r-.a tn�Fsr�ii � �2z G2A,�D �vE c'v�-rLCif 982�1 25z - SysS <br /> �RCMIIEC ORDESIONER M�IL�DDRE59 CIIY 2�P PMONE <br /> 6ENEHIILCONTR�CiOR MI111�00PES5 CIIY 21P PHONE LICENSE• <br /> MEGH�NICALC TMCTOq MML�D�FE59 CItt =�P PMONE LICEN9E• <br /> PLIIMBINOGONTMCTOR M�I�AO�FE55 Gltt 21P PHONE LICEN9E• <br /> CLASS OF WONK <br /> ❑ NEW IB�ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br /> 11LWf10 OFWORK�COSTOFMRiEflULSPLUSLABOP� <br /> ` joav , W <br /> X ESCRIBE WOY�f'�7{yl o G�.Q�Y ` � <br /> /\ S .� <br /> M <br /> �eE ov euao�No I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AR <br /> �� dU_t� <br /> PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT.ALL <br /> L O�LDESCRIPTIONOFPROPENiY15HOWNBEIOWOAATT�CNFOURCOPIES� pROVISIONSOFLAWSANDORDINANCES60VERNINOTHISTYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE• <br /> irb`�e�ocKz� �r�L—�` G INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOIJS O� <br /> � ' ANYOTHERSTF.TEORLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTIO <br /> SIQNATURE OF CONTMCTOR OR AUTHORI2ED AOENT �OATE�o/Z�/� <br /> X��I� r� G✓.c.�� U- �/0 <br /> PROJECT ADDRESS �PPLICANiS CITY BUSINESS LICENSE NO. <br /> �� f o 2 2 �j ✓.-.-� !1 v-t �C�.vu�� cv�fl <br /> PLUMBIN4 MECHANICAL <br /> Np, TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSE7 TOILEn AIR COND.UNITS—H.P.EA <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> LAVATORY WASH BASIN) BOILERS—H.P.EA <br /> SHOWER OAS FIRED AC.UNITS—TONNFOE EA <br /> KITCHEN SINK 6 OISP. FORCED AIR SVSTEMS—B.T.U. M E0. <br /> DISHWASHER WALINEATERS—B.T.U. M <br /> LAUNORYTRAY UNITHEATERS—B.T.U. M <br /> CLOiHES WASHER EVAPORA7IVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINRL VENTILATION FAN <br /> ORINKIN6 FOUNiAIN RANGE HOOD <br /> FLOOR DRFIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF ORAINS—RAiNIEADEFS METAL FIREPLACE 6 CHIMNEV <br /> SINK SERVICE—BAR.ElC. WOODSTOVE/FIREPLACEINSERT <br /> SUBTOTAL 8UB TOTAI f <br /> PEPMIT f PERMIT • <br /> TOTALFEE f TOTALFEE i <br /> � THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FpONT SETB�CR RE�P SETBACK SI�E SEiBACN PUN CNEGK NUMBEF VLAN CNECK FEE <br /> '_ �� O //I 3 J 7 Y FEE . �� RE�U`� I <br /> USEZONE LO��REA V�C�NTSITE FEEB ���U�TION FE[ <br /> _ OYES Y[!O <br /> TYPE OF CO�N9/T. OCGUPANGV GROUP NO.OF DWELLIN6 UNITS <br /> � f�i R� �� BUILDING f <br /> 512E OF BLDQ NO.Of G'OHIES MAX OCG LO�D <br /> 1 PLUMBIN� <br /> MECHANICAL <br /> FtRE SPRINKLERS REOUIRED ❑VES NO o7NER <br /> PENALTY <br /> APPLICA710N ACG.BY PUNS CNECRED BY �PPN.FOR 195U�NCE GY <br /> TOTAL <br /> � � J�� <br />