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-.-'APPLICATION Fl.: R ���«n <br /> �^•E�°�^ CONSTRUCTION � e <br /> GItY Of <br /> everett PERMIT <br /> TO BE COMPIETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDINa ❑ MECHANICAL ❑ P9.UMBINQ SIGN <br /> CIIY 21P PIION[ <br /> OWNEN M�IL�DORE54 ,��_ ,� <br /> i ^ , � i" <br /> f . � � ' CITY ' 21P PHONE <br /> ARCNIIECTOROl910NER M��LAOOPESS <br /> OENEMICONTPRCTOP M�RADORESS <br /> CITY 21P PMONE LICENSE� <br /> MECN�NIC�LCONTMCTOfl MMLII�ORE55 <br /> CIiY 21P PHONE LICENSE• <br /> ►LUM�INOCONTMCTOR M��LADOPE39 <br /> CIIY 21P PIIONE UCENSE• <br /> GLA750F WORN <br /> � ryEy�r ❑ ADOITION ❑ ALTERATION ❑ R[PAIR ❑ DEMOLITION C�-I�WOODSTOVE/FRPL.INSERi BUILDING FiELOCA710N <br /> V�LUATION OF VIOPN�C09T OF MA1E111�L9 PLUS L�BORI <br /> IA!S`�// �in ,• c <br /> oescrTie�wonK'— <br /> uaeorouuou+a I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS AP• <br /> ��r�� � /)r7/C4� V-S1 . �'vC PIICATIONANDKNOW7HESAMETOBETRUEANDCORPECT.ALL <br /> LEOIILOESCRIPTIONOFPHOPENTY�SHO�MNBEIOWaNATTACIIFOUNGOPIE51 OFWORK�WIL�LBECOMPLET�EDDWITHWHETHEHSP CFIEDHERE- <br /> �or_—e�ocK_oF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> ANYOTHERS1IAlEOR OCALLAWREGULATINGCONSTRUCTION <br /> OR THC PERFORMANCE OF CONSTRUCTION. <br /> SIONATUNE nOF CONTRACTOR OR AUTIIONIZED AGENT UATE <br /> X / _' p <br /> . <br /> APPLI NTSCITYBUSINESSLICENSENO. <br /> VROJEGT�DDRE39 <br /> � t� � � � — <br /> PLUMBINO ^ MECHANIC�L FEE <br /> TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT <br /> NO. pIR COND.UNITS—N.P.EA <br /> WATER CLOSET TOILET) qEFR16ERATION UNITS—H.P.E0. <br /> BIITHTUB BOILERS—H.P.EA. <br /> UIVATORV WASH 9ASIN) GAS FIRED AC.UNITS—TONNAGE E0. <br /> SHOWER FORCED AIF SYSTEMS—B.T.U. M E0. <br /> KITCHEN SINKB OISP. <br /> , WALL HEATERS—B.T.U. M <br /> DISHWASHER UNITHEATERS—B.T.U. M <br /> LAUNDRY TRAY EVAPOMTIVE COOLERS <br /> CLOTHES WASNER CLOTHES DRYEFS <br /> W�iER HEATER yENTILATION FAN <br /> URINFL RpNGE HOOD <br /> ORINKINO FOUNTAIN <br /> pIR NANULING UNIT— C.F.AI. <br /> FLOOR DRRIN STOVE <br /> VACUUM BAEPKEFS METAL FIFEPLACE 6 CHIMNEY <br /> POOFORAINS—R�INLEADERS WOODSTGVE/FIREPLACEINSERT <br /> SINK �EFVICE—BAR,ETC. <br /> SUBTOTAL s <br /> SUBTOTAI pERMIT s — <br /> PERMIT f TOTAL FEE � <br /> TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PLA4 CNECB NUMBEN PUN GIIECK fEE <br /> iflONiSETB�CK RE�RSEtO�GK SIOESETB�CK rEE RLCEIPiNO. <br /> LOT�RE� yACANT5IIE FEES V�LUAiION FEE <br /> U51:20NE pyES ONO <br /> IYPEOFCONSG OCGUPANCYGROIIP NO.OFOWELlIN6UNIiS <br /> DUIL�ING f -- <br /> SRE OF BL00. NO.OF SIORIES M�K OGQ LOAD <br /> PLUMOINO <br /> MECNANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑NO pTNER <br /> PENALTY <br /> �PPLIC�t�ON�CC.BY PUNS CIIEGNE�BY �PPR FOB ISSU�NGE OY TOTAI <br />