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�� � . .PPLICATION F�.. � . <br /> TM�"'°'""' CONSTRIlCTION ��"`" <br /> everett �ERMIT P+ <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINl' <br /> BUILDING DEPT. <br /> 259•8745 ❑ CAMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING � SIGN <br /> OWNER MAI!�DDPF53 CIIY 21P PHONE <br /> ��OV/GC.4 ?a�c.� 19z1 o�,CEs ��E/�n �20 1 �s8-GZA 1 <br /> •RCMITECfORUE510NER MAILeDDPESS CITY ZIP puONE <br /> GEN[P�LGONTR�GTOF' ' � DMML��DRESS •. CITY � . =�p PNONE UCENSE� <br /> C�/T� yG.✓ J�R✓2c= ro ,d�Y. Z2i7 .�u"2ETl �drZd 3 .�39 Z6�/� t//ystJ/58G�C <br /> NEG�IANIC.:L CONTR�CT017 MAIL 1100RES5 CIIY 21P PIIONE IICENSE• <br /> ?LUMBINGCONTP�CTOR M�ILADPflE55 GITY 21P PIIONE IICENS[• <br /> f.1�550F WORN <br /> � NEW ❑ ADDITIC�N ❑ ALTERATION ❑ REPAIR 7 UEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOC.�TION <br /> ��lU�iION OF WORN�COST OF MAIERULS PWS L�BOH� <br /> I�ESGPIBE WORN <br /> r�.srac� F�q� ..,au�r .s�c.✓ �i ci,ceu.r� <br /> IlSE OF BUILOING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> G�Uf �,[iu7i�t/l PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.AIL <br /> LEG�LDESCRIPTIONOFPROPERTY�SNOWNBELOWORATTACHFOUNCOPIES7 PqOVISIONSOFLAWSANDORDINANCESGOVEFNINGTHISTYPE <br /> ES% 0 / LOT /A �FWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> ��'�---� IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> BCOCK �8G � d£�d71 ANYOTHTRSTATEOR OCALL�AWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNA7UNE CONTRACTORORAUTNORIZEDAGENI D�'E <br /> X �.,.�- 3-�T-b'� <br /> PPOJECT�DOPESS APPIIC�NiS GITV BUSINESS IICENSE NO <br /> �Fr,/ o.�r�s E'��rr c�� �za r /lo '/p(o <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EpUIPMENT FEE <br /> WATER CLOSET�TOILEI) AIR COND.UNITS—M.P.Eq. <br /> BATHTUb REFRIGERATION UNITS—H.P.EA. <br /> LAVATORY�WASM BASIN� BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AC.UNITS—TONNAGE EA <br /> K�TCMEN SINK d DISP. FORCED AIR SVSTEMS—B.T.U. M EA. <br /> OISHWASHER WALL HEATERS—B.T.U. M <br /> LAUNDflYTflAY UNITHEATERS—B.T.U. M <br /> 1 CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATEH HEATER CLOTMES ORVERS <br /> ! URINAL � VENTILATION FAN <br /> � DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN Alfl HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> � ROOF ORA�NS—RAINLEADERS METAL FIREPLACE 8 CHIMNEY <br /> - SINK SERVICE—BAR,ETC. WOODSTOVE/FIREPIACE INSERT <br /> SUBTOTAL SUB TOTAL S <br /> PEXMIT f PERMIT f <br /> TOTALFEE 1 TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iNONTSETB�CK AE�RSETBACN SI�ESETB�CK PL�NCNECKNUMBER P:nNCNELNFEE <br /> FEE i�ECE1PT N0. <br /> USEZONE LOtA�E� yAC.WT5ITE � <br /> OYES ONO FEES VALUATION FEE <br /> TYVEOFCONST OCCUV�NGYGROUP NO.OFOWELIINGUNITS <br /> BUILDINO S <br /> S12E Of BlD6 NO OF STOPIES M�K OCG LO�D <br /> P�UMBINQ <br /> MECMANICAL <br /> FIR[SPRINKLERS REOUIRED ❑YES ❑NO <br /> OTMER <br /> PENALTY <br /> �PPIiCAt10NACC BY PIANSGHECKEDBY APPP.FOfl155U�NCEBY -- --- <br /> �� TOTAL <br /> i�'KJ MA1F-cMUM PRU1t�-�tev Or� l.o-►Y- <br /> Px.�T �C� GLO �z�2, �j..L-p�J $'fT <br /> '+,I zsl-��C'P ��.• '�'� f'�c.6 or� c.ua�s , <br /> � �,_�,.._ <br />