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'._:PPLICATION FO�.% ��«<n <br /> �:�"^ CONSTRUCTIOf��! 0 <br /> everett PERMIT <br /> BUILDING DEPAR7MEN7 TO BE COMPIETED IN INK• PLEASE PRINT <br /> 259•B'745 <br /> O DEMOLITION ❑COMBINATION �BUILDING ❑ MECNANICAL ❑ PLUMBINO ❑g�aN <br /> MI1IL�DDNES7 c'n r'° n�°NE <br /> o""'E" �UtYi.tr WA 9F57.�i z�Fs-�fs49 <br /> ISr INit�At£ �tK I�f.� B�K 4 <br /> MCNIT[CTOIIOEMOMEII <br /> M1111�ODRESS Cltt 21P PMOHE <br /> M�IL�OUPESS CITY 21P PHOHE LiCFHSE• <br /> OEMEMLCONTN/�GTOR 4-85-S�1A3 �50G2�Iblo6 <br /> A�ssexin� �axiNa �o i�c eza9� K�m�a.E us�i- 9bo�s <br /> yEp111NIC11LCONTMCTOq M�IL�DORE39 <br /> CIfV 2iP �NOME IiGENSE• <br /> ��n. Z�p M�ONE LICENSE• <br /> KUMMOCONiMOTOA MMI�DDRE9S <br /> aua a woaK <br /> � NEyy ❑ AODITION ❑ ALTEF�T�ON � AEPAIR ❑ DEMOLITION ❑ WOODSiOVUFRPL.INSERT BUILDING AEIOCATION <br /> �p�}pq pf yyp11M�CODI Oi MMERIIL!%U!��eCF� <br /> 3505 <br /> o��7a7��r n� <br /> w[o w��N�� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS AP• <br /> ��K PLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALl <br /> �pµp�k�phpFpllpPERTY�lNOWNBELOWOR11tT�CNiWNCOME& PROVISIONSOFLAW3ANDORDINANCESOOVERNIN6TNISTYPE <br /> OF WORK WILL BE COMPLETED WITH WH ETNER SPECIFIED MERE- <br /> �or_e�oc�—o� IN OR NOT.THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO <br /> ANYOTHERST1ATEORIOCAI AWREGULA IN4CONSTRUCTION <br /> OR THE PEHFORMANCE OF CONSTRUCTION. <br /> SION11tUAE OF CONTRACiOR OR AUTNORIZED�GENT D�TE <br /> X�...�UTA�IYV� -� ��2-�1 ��'!n <br /> qqJECl�Op11E6! �PPLiG�Mi9QfYlUSMESlUC[�5 NO.�� <br /> t\. I <br /> 16az +�c.��c. A•►G �v <br /> �LUM�INO MECNIIHIC�L <br /> Np. T'I�E OF FlRTUIIE <br /> FEE NO. T'pE OF EOUIPMENT FEE <br /> �IR CONO.UNITS-X.P.E�. <br /> W�tER CLOSET(TOILETI <br /> . REFRIOER�TION UNITS-N.P.E� <br /> BI1iNTUB <br /> LAVATORV WASN BI151N) BOILERS-N.P.E11. <br /> 6115 FIRED AC.UNIT9-TONN�OE EA — <br /> ��p FORCED��R gYStEMS-B.T.U. M EA. <br /> KITCNEN SINK{DISP. <br /> W�LL HEATERS-B.T.U. M <br /> DISNW�SHER <br /> UN�TNEAtERS-B.i.U. M <br /> LAUNDNYTR�V - <br /> EVAPORATIVE COOLERS <br /> CLOTHEB WASHER GLOTHES DRYERS <br /> WI17EH ME�TER <br /> UN�N�I VENTIL�TION FAN <br /> R�NOEHOOD — <br /> DPINNINO FOUNTMN <br /> �IR HANDLINO UNIT- C.F.M. --- <br /> FIOOR DRAIH STOVE <br /> VIICUUM BREAKERS <br /> ROOF DRAIHS-P�INLE�DERS METAL FIREPIAGE 6 Cl/IMNEV <br /> SINK SERVICE-B�P_ETC. WOODSTOVE/FIPEPUCE INSERi <br /> SUBTOTAL s <br /> 6UB�OTAL — s <br /> PENMI� t FERMIT <br /> TOTIIL FEE • <br /> �OTAIFEE � <br /> THIS PCRTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PUN CIIECIt NUMBER tt�M GHEGh fEE <br /> 'ROM1 SEfB�CIt REAR SEIB�C4 SICE SETB�CK RECEIPI NO <br /> fEE <br /> JSEZONE tOfANE� y�C�N151tE FEES VIILWTIOM FEE <br /> OYES ONO (�.j1 I O <br /> �rVEOfLONSG OCGU��NGYGROUP NO.OFDWElLINOUNILS <br /> WV �tt� SC <br /> BUIL�ING � , <br /> 512E Of BLDQ NOAf StOPiES M�M.004 LO�D <br /> PLUM0ING <br /> I.�ECNRNIC�L ._ <br /> FIRE SPRINKLERSiiEQU1RED ❑YES ❑NO oiHER <br /> PEN�LTY _ <br /> +PPLIC�IION�GC.BY �L�NSCNECKEDBY ��FN fOR15511�NCEBY � <br /> ' � TOT�I <br /> � _. <br />