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�,E,,,,,,,, �;-.PPLICATION FOr� M,�„ <br /> °�°� CONSTRUCTION <br /> everett PERMIT e <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBINU ❑ SI(iN <br /> OWMER MML�DDPESS CITY 2�P PMONE <br /> -ti�, ���i��I�/�.� �i�7 /�F�'. .Z2/Z Jh�i��t ��r �iirY'r'ff' �j5'^c> > £�/ i�C <br /> M1LMIlEGTqIDES�ONER M�IL�OORElS Cltt Z�P FHONE <br /> � <br /> �iC•�'i. 1• �iCC� �.�o�-�aJ� s�/� ��'�rv.(r' l�•7. %�S�'!'S •'!/�' LI:L- <br /> OENEMLCOMTRICTOR �' M�ILIIDDRES4 CIIY 21P CHONE LIGENSE• <br /> �"��.f1�`;�t' /•'ctn iSLr� /'L. ✓1��' /Sr•��rv.yr- ���n J,Si-��: C�Y3 �-C26 <br /> MEGNINIG�L GONTFI1CTOq M�IL 11DDPE33 •CITY ZIP PnONE �i�ENSE• <br /> '`' i./Y�i; ���� n� � rqs� ,q/�� c°% <br /> RUMSi1�O GOHTP�CTd1 M�4�DDRE88 pfY 21p PHONE �ICENSE• <br /> 1`�l.-/�'r-/7 S�� �7 9 ,•-' .•�'75 .91�'� a��`' <br /> G1155Of WORN <br /> ❑ NEW ❑ 11DDITION O ALTERATION � REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPI.INSERi ❑ BUILDING RELOG�TION <br /> Vs W��tON OF Wpqlt�CqSf Of MAIERUl9 PlU9 UBOR� <br /> lr� =y. (` r` (+ ' P <br /> OESCHiBE WpRN <br /> �t�. // ^ �1 <br /> �4r:i-�v� / i /:S ✓4N�'/ ✓'�.i��J G� F� �cr' <br /> use or euiiowa <br /> ��/7�� u �� �. L , ���� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS AP- <br /> � � PLICATIONANDKNOWTHESAMETOBETRUEANOCORRECT,ALL <br /> IEO�LDESGR�PTIONOFVPOVEPTYI3NOWHlEIOWOHATT�CMfWqCOPlE91 PROVISIONSOFLAWSANOORDINANCESGOVERNINGTHISTYPE <br /> ,-7.)f.� ��L�o� ���/L� ' �,�ti /� ,/�/ ,�, OFWORKWIlLOECOMPLETEDWITHWHEiNEHSPECIFIEDHERE- <br /> ior_eioc IN OR NOT.THE GRANTINO OF A PERMIT DOE5 NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANV OTHER STATE OFl LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMAIJCE OF CONSTRUCTION. <br /> SI6NATUREOFCONiR�CTOFOF�UTMORREORGENY beTE�y• �1.. 5'r <br /> X . - y � <br /> -� --� �, <br /> --�-_._- ��- '�. ' i <br /> 3,l�' '' ...r G p/ <br /> ROJEG��UDOE55 1PVLIC�N SC�tYBU51NES51.�CENSENO� " � <br /> L� �� _! IG' • i G� /' / <br /> UM�INO MECMANIC�I <br /> N0. TYPE OF F10.TUIIE FFE N0. T'PE OF EOUIPMENT FEE <br /> WAfERCLOSET�TOILET) AIRCOND.UNITS—H.P.EA. ' <br /> B�THTUB REFRIGERATION UNITS—H.P.EA. <br /> U1V�TOA�(W�SH BASIN� BOILERS—NP.EA. <br /> �'�� SHOWER O�S FIqED AC.UNITS—TONNAGE EA. <br /> KITCHEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA <br /> DISHWASH[R WALLHE�tEFS—B.T.U. M <br /> L�UNDRV TR�V UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHEF EVAi'ORATIVE COOLERS <br /> WATER HEATER CLOTHES DFYEHS <br /> URINAL VENTILATION FAN <br /> DRINKINO FOUNTAIN RANGE HO00 <br /> � FIOOR ORAIN `�TT�71`I �CC'/" ' A'R M�NDLING UNIT— QF.M. <br /> _ � <br /> V�CUUM BRE�KEFS STOVE <br /> ROOF DR�INS—FAIHLEADERS METAL FIREPLACE 6 CHIMNEV <br /> SINN SERVICE—BAR.ETC. WOODSTOVE/FIREPUCE INSERT <br /> 8UB TOTAL 8UB TOTAL f <br /> PERMIT { PERMIT � <br /> TOtAL FEE • TOT11L fEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> ffiONiSEfB�C)It PE�RSEIB�C1( SIOESETB�CK PL�NCNEG NUMBER �'L4NC��CCKfCE <br /> �/� U/ CJ� 1 / / � FEE/ n� � flEf,C��O � O <br /> � d � <br /> USE20NE LOieqE� y�p�NTSrtE <br /> � - `L 7�; �''f� ❑YES YINO FEE6 V�LU�TION FEE _ <br /> IVPEOfCONSt OCCUP�NCYGROUP NO.OFOWELLINGUNITS <br /> '�—H� �" Z' CJ euaoiNc /Z�j � <br /> s¢e or ei/oa r+o or sromEs M�X pCC LO�D — <br /> �31G �j S,F � yS/ PLUMBING <br /> MECMPNIC�L <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑ NO —' <br /> OTHER <br /> PENRLT\ <br /> �PPItC�i�ON�CG.BY PL�NS GI1ECItED BY �PPq.fOq 159U�NCE BY — <br /> TOTIIL <br /> �� �� �/ff L-C. <br />