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. .PPLICAT�ON f0,_ ���,�„ <br /> '"'E""'"° CONSTRUCTION <br /> an oc � <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> [�I DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEP MNl ApORESS ��n' 21P PI�ON[ <br /> v�l//''�� L����/�'�E'G� �� � // <'f:f'S <<'r.:l'�L �;% f','r'2n / <br /> � ITEGTORUESIGNER M�IlA00RESS f.iTY ZiP PHONC <br /> GENERAI GONiFACTOR M�II appR[55 GI:V ZIP PIIONE IILENSE� <br /> MECIIANIC�L CONTR�GTOq MAII AOOBC55 CrtY ZIV PMONE LICENSE• <br /> PLUM9INGCONiPACiOR M�ILAODRLSS CIIY 2iP PI�ONE IICCNSE� <br /> CLASS OF WORN ,( �'. <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR C_Y OEMOLITION ❑ WOODSTOVE/FFPL.INSERT ❑ BUILUING flELOCATION� � <br /> ! <br /> WW�TIONOiWORN�LOSTOFM�TEHiAl5PW51A�g1pRI I <br /> �d G� C�'HL 1 J Lt✓(/ <br /> OESCRIBE WORK I <br /> USEOFdU1.01Y0 I IIEREBY CERTIFY lHAT I Ft.^.VE READ AND EXAMINEU THIS AP• <br /> � � PLICATIONANOKNOWTHESAMeTOBETRUEANDCOflRECT.ALL <br /> IEdAL SCRIP IONOF,P,�RO1PERiY NOWNBE OWOf1�TTACIIFOUPLOPI ,1 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> / /•`�..� I �7 I OF WORK WILL BE COMPLETED WITH WHETHEFi SPECIFIED HERE• <br /> io e�ocns[=-lor _ IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> - GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRCVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNnTURE OP CONINnCTOR OH AUi110RIZED RGENT D4IE <br /> X <br /> PROJECT�OONE55 A�PI.ICANiS CITY tlUSiN[55 ULENSE NO <br /> ��r � �.�'�a. ��� <br /> PLUMBINO _ MECHANICAL _ <br /> NO. TYPE OF FI%TUpE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET AIR CONR UNITS-N P.EA. ____ __ _ <br /> B�TNTUB _ HEFRIGERATION UNIiS_II P_EA __ _ <br /> LAVATORYIWASMBASIN� _ UOILERS-II.P EA__ _ __ <br /> SNOWER GAS FIRE�A C UNITS_TONNAGE EA___ _ <br /> NITCHEN SINK 8 DISf! FORCED AIR SYSTEMS_B T U M EA. __ .___ <br /> DISHWASHER _' __ WALl11EATERS-OT.U. _ M "___ ______'.-� _ <br /> LAUNORYiRAV _ UNITHEATERS-B.i.U_ M_____ _ <br /> CLOTHESWASNER EVAPORA7IVECOOLERS_______ __ <br /> WATER HEATER CI OTIIES DRYERS <br /> _'____ - --'_ _'_'_—'_""__ '____'_'_ _'___'_ "'_ __ <br /> URINAL ' _ VENTII.ATION FAN_________ __'_ "_ <br /> [1RINKIR i FOUNTAIN -- — —— —'_ qANGE IIOOD__ '_'__'___ _'__'_ � — <br /> FLOOR DflAIN AIR HANOLING IINIT—__C F AI. __ <br /> VACUUM BREANERS STOV[ <br /> POOF ORAINS—R�INLEADERS METpL KIREPIACE 8 CIIIMNLY _ <br /> SINK�SEflVICE—BAF.ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUBTOTAL _ SU9TOTAL f <br /> PERMIT 3 PEflM1T_ 7 <br /> TOTAL FEE f TOT�L FEE __ f _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> LRONTSELB�f.N AE�tI5FI0�CR SII]ESLItl�CH YI�NLII[LNIIIIM�IR PI�NGIILCNiEE <br /> FE� RkCEIPI NO <br /> IISEZONE IOTAPE� �������y��E <br /> FEES VALUITION FEE <br /> ❑Yk5 IJNO <br /> ' TYPCOPCONST OCCIIP�NLYGROUP NOOFpWEl11NGUNliS <br /> BUILOING 5 <br /> SRE OF OIDG NO OF SIORIFS Id�x OCC IA�D --- <br /> PI IIMBING <br /> AILCIIANIGAL <br /> FIRE SPRINKLERS REOl11RED Q YES O NO - <br /> OIIIER <br /> PENnLiV <br /> �PPI.IG�TION ALG BY PUN$L1IECNED�Y APPB iOR ISSUANLL DY - -- <br /> TOTAL <br /> � <br /> -- � � C� ��c�7 <br />