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rn.ewrom� I'�l P P L I C A T 1 O N F O�ti•' e�eren <br /> ��r�F CONSTRUCTION e <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259-8745 ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEH MAIL�OORE55 CIIY ZIP PHONE <br /> �Uf �DC(�B�/ bvc'��,�DZZ C�/lAnJD AfJE ��C/LtTT <br /> ARCMITECT DESIONER� M�IL��OHE59 Cltt ZIP PHONE <br /> OENEMLCONTF�CTOR M��LADDRE59 CIIY ZIP PHONE LICENSE• <br /> MECH�NIC�LCONTMGTOq MAII�OpFE33 Cltt ZIP PNONE LICENSE• <br /> h�,o,��oN /{c�n,v� �o.Sox iri sr J3ei/�n��f,�� 9saa'� G96//3/ �i1.2Roh'.Z'73DZ <br /> PLUMBINOCONTR�C70f1 M�IL�ODPE59 Cltt 21P PHONE LICENSE• <br /> G1A590F WOflN <br /> ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> V�IU�T10N OF WORK�LOSi OF M�TEHI�LS PLUS L�BOfq <br /> UESCRIBE WORK <br /> U9E OF BUILOINA <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br /> PL ICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT.ALL <br /> IE��LDESCRIP110NOFPROPERtY�SHOWNBEIOWOR�TTACNFOUPCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHISTYPE <br /> ��T � i/C r A4D.�b Fc OF WORK WILL BE COMPLETED WITH WHETHERSPECIFIED HERE <br /> ior e�oc or � INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> �. S�WtoRa�tLoT �� a •G/. te. to�` ANYOTHERSTATEORLOCALLAWREGULATINCaCONSTRUCTION <br /> �L OR THE PERFORMANCE OF CONSTRUCTION. <br /> r/rc/�� TA[p1G •L+dG F�� OI��rO G G SIONATUFEOFCONTRACTOROFiAUTNORIZEDAQENT DATE <br /> �G(�tll//.WIfNeYLy NLCAb E1157'�.,.NG Ji9/[�,c � �S•LIN[ ^� CGG � P td-rc� 7/7-�5� <br /> PROJECTIIUOFE59 LOt e7/ (.KT. {(/fy y/��/I AfT •O• , APPLIC�NTSCITY SINESSLICE ENO. <br /> o a �' � /�E. «-� c��. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TUHE FEE NO. n'PE OF EGUIPMENT FEE <br /> WRTER CLOSET�TOIIET) AIR COND.UNIT3-H.P.E0. � - <br /> B�THTUB REFRIOEflATION UNITS-H.P.EA <br /> LAVATORY WASH BASIN) BOILERS-FI.P.EA. <br /> SHOWER OAS FIRED AC.UNITS-TONNAOE EA <br /> KITCHEN SINK 6 D�SP. FORCEO AIR SYSTEMS-&T.U. M EA. <br /> DISHW�SHER WALL NEATEPS-B.T.U. M <br /> LAUNDRYTRAY UNITHEATERS-B.T.U. M ____� _ <br /> CIOTHES W�SHER EVAPORATIVE COOLERS __ � <br /> WATER HEATER CLOTHES DRYEFS <br /> URINAL VENTIUTION FAN _ _ <br /> ORINKING FOUNTAIN RANGE HO00 <br /> FLOOR DRAIN AIR HANOLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DMINS-RRINLEADERS METAL FiREPLACE 8 CHIMNEV <br /> SINK SERVICE-BAR.ETC. WOODSTOVE/FIPEPLACE INSERT <br /> SUB TOTAL SUBTOTAL f <br /> PEIiMiT f PERMIT i <br /> TOTALFEE 3 TOTALFEE 3 _ <br /> ' THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETB�CK REAR SETB�CR SIOE SETBAGN PUN GHkCN NUMBEfl VLAN CHEGN FEE <br /> FEE RECEIPT NG. <br /> USE20NE LOTAflEA y�C�NT5ITE <br /> FEEB V�LU�TION FEE <br /> OYES ONO <br /> IYPEOFCONST. OCCUPANCYGROUP NO.OFDNELLINOUNIT9 <br /> BUILDING S <br /> 512E OF BLDO. NO.OF STONIES MAK OCC.LO�O <br /> PLUMBING � <br /> MECNANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES O NO <br /> O�NER <br /> 1'ENALTY <br /> APP�ICAIIONACC.BY VLnNSCNECNEDBY �PPRFORISSU�NCEBY — <br /> TOTAL <br />