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��' <br /> APPLICATION F(1R ��«<„ <br /> I�rEqrpmn CONSTRUCTION e <br /> Cltt OF <br /> everett PERMIT <br /> TO BE COt."'LETED IN BLACK INK- PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDINQ ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWN�.E.,R/ M�ILAUDRE55 p� Gltt ZIP PNONE <br /> �/�,.y�:i.�... 4J�� .t. Z�`_ �o�'�-/J,4,,.....C� a,+.'-C �ti.�..Jn� aa�.Jv)3 <br /> ARCNI7 TOPUESIONEH M�ILAODRE59 Cltt ZIP PHONE <br /> AE ERALCONTR�CTOR M�ILAODRE59 G11Y 21P PMONE 4CENSE• <br /> (��e�,.,-� � ,,,� �.�. >A J S'7 56 �f5�..7�.�'Wmt�� 9�r0// Cus�'oGSa.siF <br /> MECN�NICAICONTR�CTOq M�IL�OORE55 Cltt ZIP PNONE L�CENSE <br /> P^LUMBINOCONTR�CIOR M�IL�ODPE55 CIiY 21V PHONE LiCENSE• <br /> {N <br /> CL�S OF WORK <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ D[MOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> W LU�TION OF WORR(C09T OF MRTERI�LS PLUS UBOR� <br /> DESCRIBE WORK <br /> useoveuuoiHa I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> � PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> IEU�LUESCRIPTIONOFPROPERTY�SMOWNBELOWONA7iACHFOURCOPIES} PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> ior._e�oc�oF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PHOVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REOULATIN6 CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATURE OF CONTRACTOR OR AUTHORI2E0�GENT DATE <br /> X � � <br /> .�n...� .F --- <br /> PPOJECT AOOHE55 APPIICANTS CIiY BUSINE57 UCENSE NC-� <br /> 1022 C-rP�u� v <br /> PLUMBINQ MECHANICAL <br /> Np, TYPE OF FI%TUNE FEE NO. 1YPE OF EOUIPMENT FEE <br /> WATER CLOSET TOI�ET) AIR COND.UNITS-H.P.EA <br /> BATHTUB REFRIGERATION UNITS-H.P.EA <br /> UIVATORV WASH BASIN) BO�LERS-H.P.EA <br /> � SHOWER GAS FIRED AC.UNITS-70NNAOE EA <br /> KITCHEN SINK 8 OISP. FORCED AIR SVSTEMS-B.T.U. M EA. <br /> �ISHWASHER WALL HEATERS-B.T.U. M _ <br /> LAUNDFiYTRRV UNIiHEATERS-B.7.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS - <br /> WATER HEATER CLO7HES DRVERS — <br /> URINAL VENiIUTION FAN — <br /> DRINNINO FOUNTAIN RANGE HOOD <br /> FLOOR ORAIN AIR HANDLINO UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINI.EADERS METAL FIREPLACE 8 CHIMNEY <br /> SINK SERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> u <br /> � <br /> SUB TOTAL SUB TOTIIL f <br /> PENMIT f PEHMIT s �� <br /> TOTAI fEc f TOTIIL FEE f � <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSON�=L <br /> FPONTSETB�CK AE�RSEiBACK S�OESETBAGK ^L�NCNEGKNIIMBEN CL�NCNECKFEE <br /> FEE HECEIPT NO. <br /> USE20NE �aT�AE� VACANiSITE FEES VALUII�ION FEE <br /> OYES ONO <br /> TYVE Of CONST. OCGUP�NGV GROUP N0.JF DWElLINO UNITS <br /> BUILDING f <br /> S12E OF BL00. NOAF ST081E5 MAX OCC.IO�D <br /> PLUMBING <br /> � MECHPNICAL �Q <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑NO O7HER <br /> PENALTY I . __ <br /> �PPLICAiION ACC BY PLANS CIIECNED OY APPP.FOR ISSU�NCE BY �� Q <br /> TOT�I <br /> G, � . L � G <br />