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7�w� h� �� 16�j ,/M � <br /> . .PPLICATION FO�. ���,�„ <br /> G�"'°'"" CONSTRUCTION <br /> everett PERMIT P+ <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETEO IN INK- PLEASE PRINT <br /> ❑ DEMOLITION �COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �IGN <br /> OWNER MMLADDRE55_ Cltt ZIP PMONE <br /> COI-4.hA�n Y�Afn.i a./f3 /�ar�j=rc Ew�T �re2ol �$-�'OL�'� <br /> �RCHITEGTONDESIG R M�IL���RE55 CItY IIP PHONE <br /> �v �s1�9 �nr�-��- <br /> GENER�L COHTR�GTOR � M�R AODRE55 GITY ZIP PHONE LILENSE• <br /> �'�ro /YIONL�r�C + ASsac /j� e�oc) CLv�- So . �A�u�aS 9b'��o "� �'�-�SC�/ SiMM4/C9�nf <br /> MEGN�NICALGONTR�LTOq MAIL�DORESS GITY ZiP PHONE UCENSE• <br /> PLUMBINGGONTP�CTOR M��I�ODRE55 GITY ZIV PIIONE 4CENSE� <br /> CLASS OF WOFN <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRf'L.INSERT ❑ BUILDING RELOCATION <br /> V�W�T�ON Oi WORK�LOST OF M�TEHUlS P W 5 L�BORI <br /> �doo =6 <br /> D[SCRIBE WOPK <br /> ZNsnta 41fC � ,r �„ FxS�S� S�a�F. <br /> USE OF BUILDING I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> LEOAL�ESCRIVTIONOFPROPERTYISMOWNBELOWOR�TTAGHFOIIRCOPIE51 ppOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT_BLOGIL�OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REl3ULATIN6 CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIDN�TURE OF CONTF�JTOR OR RUTNOPIIED AQENT D�TE C�? /�Q,j <br /> X � ��-_ <br /> PROJECT ADORE55 APPLIC�NTS GITY BUSINESS LICENSE NO. <br /> PLUM�INO MECMANICIIL <br /> NO. TTE OF fl%N11E FEE NO. T'PE OF EOUIPMENT FEE <br /> WIITER CLOSET(TOILE AIR COND. UNITS-N.P.EA. <br /> 91�THtUB REFRIGERATION UNITS-H.P.EA. <br /> L�VATORV WA9M B�SIN BOILERS-H.P.EA. <br /> gMpyyEq GAS FIRE�AC.UNITS-TONNAGE E4 <br /> NITCHEN SINK 6 DISP. FORCED A�R SVSTEM$-B.T.U. M EA. <br /> 019MWI15HER WALL HEATERS-B.T.U. M � <br /> LAUNDRYTRAV UNITMEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPOFATIVE COOLERS <br /> WA7ER HEATER CLOTMES DRVERS <br /> URINAL VENTILATION FAN <br /> DFINKING iOUNTAIN R�NGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M, <br /> V�CUUM BREAKER9 STOVE . <br /> ROOF OMINS-RMNLE�IDERB METAL FIREPLACE 6 CMIMNEV <br /> SINK SERVICE-BAR,EtC. WOODSTOVE/FIREPLACE INSERT <br /> �U�TOT�L 6USTOTAI • <br /> ►EIIMIT • PEIIMIT t <br /> TOTALFEE t TOTALFEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDIN(a DEPT. FER50NNEL <br /> FPONT SETB�LK RE�R SETB�CR SIDE SETB�CN PL�N CMECN NUM9ER PLRN CNEGN FEE <br /> .� �--- . '///�� FEE AECEIPt NO <br /> 7 '�� <br /> USE 20NE � LOi AREl1 y�CANI SITE <br /> Rl' l pYES f]NO FEE! V1LU�TION FEE <br /> ,y� <br /> TYPEOFLpNST. OCLUPANCVGROUV NO.OFpWELLIN6UNIT5 <br /> BUIL�ING f � �� � <br /> SRE OF 6�OG. N0.OF STORIES MAX.00G LO�D <br /> PWMBING <br /> MECMANI�AL <br /> fIRE SPRINKLERS REOUIRED ❑ VES ❑ NO j�� / <br /> flTnFR— <br /> 4NF1kii' <br /> APPLIGhT10NALC BY PL�NSGMECKEOBY �PPR.FORISSU�NCEBV ''7/. <br /> ' TOTIIL \� /J <br /> �M 23 9� <br />