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• 1 <br /> �� PPLICATION f�c ���.�„ <br /> ""E"'°'"" CONSTRUCTION 0 <br /> u,.o. <br /> everett PERMIT - <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING � MECHANICAL � PLUMBING ❑ SIGN <br /> OWNEP M�IL110DRE55 f.IP/ Zn' ✓HONt <br /> rAn�►�� T� (Yl(�T`(A� ILIl�S �^�ak5 Rvenur F ��.��f f �a � • 391� ^ �- - � , <br /> •pGNITECiONDES�GNER M1l�ODNE53 CIY If PHONC <br /> OENEMLCONtR�CTOR MML�DDPE53 CitY ZiP t9�ONE IICCNSE� <br /> \ <br /> \lo��e N6'Ivirnl C�o.._t << . l/9�� �it��l �� fue H 9S'�'�� �,-5. 77�C� V�a1J_�NG--/53 <br /> MEGH� 1 �LGONTRAGTOq M�ILIA�RE55 CIfV Z�P ���0 E LCENSE <br /> FLUMBINpGONiR�CTON MMLADORE55 CII� ZIP PMONE ��IGENSE• <br /> CLAS.40i WOAK � <br /> �NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL,INSERT ❑ BUILDING RELOCATION <br /> V�W�T�ONOFWOHN�C09TOFMATFAqL5PW5��BOR1 ���� (] <br /> �4()��c?G +� -7�-II°C> 33G41 �`� <br /> OESCRIBE WOPIt <br /> � r� . � ,, _ �. � . . - • i r- . -- �c • <br /> us¢oreuitou+o I HEREBY(:FRTIFY TH�T I HAVE READ ANn E%AMINED THIS AP• <br /> PLICATIONANDKNC�WTHFSA�dEIUBFTRUEANDCORRF�! ��' ! y � <br /> LEOALDESPOVPONOFPPnpfprvi$up�VNBEIOWOP1n�CHfOURLOPRS (�Rl�lilOt:'. . . . . . . �. . . •�� H <br /> ..� . . �). H � <br /> wr_—uiow.--u� _--'—'--'— . INUH IOI. iHi � ,����Illc.��:l yI1J�f.i�i �� .�..�....il : ,. :. � fA <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF- � <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. y <br /> SIGN�TUR[OI'CONTRAGfORORA07110N12E0AGENT DAiF Q <br /> X �, r /� �:.��,, /1l�!�/8� � � <br /> � . � �aDOAE59 + � O �°PLIC� fSCIfY9USiNf.SSUGCN5F 10 �' <br /> � <br /> .. { � � � ' 1 I-� , � <br /> M <br /> VLUMSINO MECNANICIIL N <br /> NO. TTE Of fIKTU1IE FEE �0. rPE OF EOUIPMENT _ FEE � � <br /> WATER CLOSET 7011E1) AIR COND.UNITS—H P.EA. <br /> 9ATHTUB REFRIGERA�ION UNITS—H.P.EA. <br /> LAV�TOflVIWASH BASIN� BOILERS—H.P.EA. — N <br /> GAS FIRED A.C.UNITS—TONNAGE EA _ N <br /> SHOWER � � � <br /> KITCHFN SINN 6 DISP. FORCED AIR SVSTEMS�ST.U.�M EA. +%,'�(,_ <br /> DISHWASMER WAU.HEATERS—B.T.U. �� <br /> IAUNDRV TR�V UNIT HEATERS—B.T.U. M . � <br /> CLOTHES WASHER E�APORATIVE COOLERS <br /> WATER HEAiER CLOTNESDRVERS <br /> URIN�L VE�TILATION FAN <br /> DRINKINO FOUNTAIN RANGE MOOD � <br /> FIOOR DRAIN AIP MANDLING UNIi— C.F.M. <br /> VACUUM BREANERS SiOVE � <br /> ROOF DMINS—RAINLEADERS METAL FIREPLACE 6 CHIhINEY — H <br /> SINK SERVIGE—BAR.ETC. WOODSTOVE/FIREPLACE INSER! UI <br /> c�.�s 3��N _ va � <br /> u�A ._ ��; .� � <br /> ----- — f� <br /> 8UB TOTIIL SUB TOTAL_ f �2 � <br /> FERMIT _PERMIT_ f _ �C �9 <br /> TOTAL FEE i T0TI1L FEE _ s 5�� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fPONT SEIBI�CK RE�R SEiB�CR SIOE SETBACK <br /> PL�N LNEG:NUMUCii PI�N CNLCM�EE <br /> F[E HlCEIPINO <br /> USEZONE IOT�PE� y�C�NT51tE pEEg V11W11IION FEE <br /> �1E5 ONO -- <br /> ttPEOiGONST. OGCUP�NGYGROUP NOA�OWELUNOlIN115 <br /> BUILDING S <br /> S12E OF BLDG NO.OF STORIES MAR OLC.LO�U <br /> PLUMBINC <br /> MECNRNICAL (r � <br /> FIRE SPRINKLERS REOUIRED 0 VES ❑ NO OiHEa <br /> PENRIiY <br /> �PP4CAti0N�GC.BY PUNSLHECNEO BV �PPR FOP 15511�NCE BY ----- � � ��y� <br /> TOT�L � V <br /> LG �. . c . --- --- ------ - <br />