Laserfiche WebLink
� -- <br /> �-iPPLICATION FOr'�� ���,�„ <br /> ,°.E"'°"� CONSTRUCTION e <br /> cm or <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PlEASE PRINT <br /> BUILDIN(3 DEPT. <br /> 259•8745 ❑ COMBINATION -��BUILDING ❑ MECHANICAL ❑ PLUMBINCi ❑ SIGN <br /> OW ER MML�DDRESS '7�!' �J, �(��l1 CITY ZIP PNONE <br /> �AN�'LP,vrj� C�-{,{�z��5 S�;} . �s8�.�3 7Y 3 ��s6� �' <br /> ♦RCNITECT0110ESIONER M�IL�DDRESS CITV ZIP PMONE <br /> N/�} <br /> OENERALCONTNICTOR M�ILAODRES GITY ZIP PNONE LtCENSE• <br /> L�sc.�A'� �a+�•>;_ !vC • �(��� ,�v�co+t4 �4v'FN S£A q��3 �S't-'/3ou <br /> MEGH�WC�LCONTR�GTOq M�ILAODRE53 Cltt 21P PMONE LIGENSE• <br /> 2.Z 3-�i-�A s o-l�,c-373 N/ <br /> PLUMBINOGONTR�CTOR M�I��O�qE55 CITY ZIP PMONE I.ICEN9E• <br /> CL�SS OF WORK �y�/� <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION YT REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINO REIOCATION <br /> �♦W�TION OF WORN�COST OF M�TERULS PLU9l�BOR� <br /> -7yv�,�-. <br /> DESCRIBE WORK 'n � � / <br /> 1�2�C� �V�-41�4'\IUVI..%;/i�ncat� (✓ LL7L'J. ��lJa�A1C� . ��t�Cl�W.�Lt <br /> USE OF BUILUINO <br /> ��l�t r; '� �< < I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> -S '�'��� �� -� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEO�LDESCRIPTIONOFPROPEPIY�SHOWNBELOWOP�TT�CHFOUNCOPIES7 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ior'r e�oc�r_ L'Jf-�z4iT OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANYOTHERSTATEORLOCALLAWREGULATINGCONST C ION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUR CONTRAC�TOR AUTHORIZEOAGENT OATE �� 4I $f• <br /> X C `'�-�ZGf�� <br /> VpP1EGT ADDRE59 �PFLICRNiS CITY BUSINE55 LICENSE N0. <br /> ?�L��� p�K�S ,`�V'z £ ;iz.�i'i <br /> PLUMBINO MECHANICAL <br /> NO. TVPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND.UNITS—H.P.EA <br /> B�THTUB REFRIGERATION W1IT9—H.P.EA <br /> LAVATORY WASH BASIN� BOILERS—H.P.E0. <br /> ' SHOWER GAS FIFED AC.UNITS—TONNAGE EA <br /> KITCHEN SINK 6 DISP. FORCEO AIR SYSTEMS—B.T.U. M EA. <br /> DISHWRSHER WALL HEATERS—B.T.U. M <br /> LAUNDPVTRAY UNITHEAiERS—B.T.U. M <br /> CLOTNE3 WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTIIATION FAN <br /> DHINKINO FOUNTAIN RANGE HOOD <br /> FLOUR ORAIN AIR HANOLING UNIT— C.F.M. <br /> VACUUM BREANERS STOVE <br /> ROOF DRAINS—RAINLEAOERS METAL FIREPLACE 6 CHIMNEV <br /> SINK SERVICE—BAR.ETC. WOODSTOVE/FIREPLACEINSEfiT <br /> SUB TOTAL 8UB TOTAL S <br /> PEPMIT S PERMIi f <br /> TOTALFEE 6 TOTALFEE 3 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> °NONTSETB�CK REARSETBACK SIOESETBACK PLANCMEC NUM9ER PLANCNECRFEE <br /> �j}r .���/ FEE � �,i= RECEIPIND. <br /> 'JSEZONE LOT�RE� ��� <br /> VACANTSIfE FEES V�IU�TION FEE <br /> pYES pN0 <br /> tYPEOFCON9T. OGCUPANCYGROUP NO.OFOWELLINOUNITS <br /> BUILDIN6 S <br /> 512E OF BL�O. NO.OF STORIES MR%OCG�O�U - <br /> PIUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO — <br /> OTHER <br /> PENALTY <br /> >PPLIC�TIONACC.BY PUNSCHECKEDBY �PP0.FORISSl1�NCE8Y <br /> T0TI1L <br />