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�,.'PLICATION FOR�.-. ��«:n <br /> . �^,""°'"" CONSTRUCTION � <br /> CIfP OR <br /> everett PERMIT <br /> , BUILDIN(3 DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br /> 259•8745 <br /> Ll DEMOLITION O COM8INATION ❑ BUILDING O MECHAPiICAI ❑ PLUMBING ❑ SIGN <br /> �iTM ZiP PHONE <br /> �j�Eq M�ILADDRES9 <br /> cv � L i°r �'i iv 3�� c,.:4 iu} 5��411te 9dla:� ✓�/�7'8?/� <br /> (�j�Q���' 'uN M�n�ooness un z r rHor+e <br /> •RCHIIECT UR DE910NER n a��3 ; ��/1 G n!b <br /> �AU�1�CS (��� 6AS � �9�2 I��Y�4�G �'f /1�-eI /{ 2LV ���N�C � FNONE uccNse• <br /> � OENE�LCONIN�G70R MAIL�OOAESS <br /> 5i� b[oriFl � ►�s�� <br /> �jS.p�164[t� G Mu,.�ooness cin zia PIIONE l¢ENSE. <br /> MEGN�N�C�L LONIMC�Ofl <br /> � M11lAU0RE9S Gltt 21P PI10NE 'J LICENSE• <br /> p M6�H7GOHif111GtOR ��1�3�7s3• <br /> � ��i und �lu edrn <br /> c«uo vronK <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVEIFRPL.INSERi BUILDING RELOC�TION <br /> V11LU�IIONOiWORKI��T��`��gP������� ��.��� r���,� r.5� b�c <br /> DESCRIlE WORN � � <br /> � 141� 'NOUSE (�I$�UC�10 <br /> uee or euaoina � � I HERE�Y CERTIFY TfiAT I HAVE READ AND E%AMINED TkilS AP• <br /> � R�S�dtu[C PLICATIONANDKNOW7HESAMETOBETRUEANDCORRECT.A�_L <br /> LEO�LDE9CA��110NO�P�pERIY�9110WNq0ElOWOR�1iACNfWRG01`IE51 OFWORKWIL�LBECOMPLE EDDWI HWHET�HE,HSP CFIEDHER£ <br /> 1�• + ���k«<�` INORNOT.THEGRANTINOOFAPERMITDOESNOTPRESUMETO <br /> 1O�b BLOC�-OF GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTH ER STATE OR LOCAL LAW REOULATI IJQ CONSTRUCTION <br /> � OR 7HE PERFORMANCE OF CONSTRUC710N. <br /> 910N� UREOFCONiRACTOROII�UfHORIZEDAGENf D�fE <br /> x 1,�--� �' /�� -�°l,l�� G /� ti' <br /> APP4L�NI'9CIlYBUSINE94lICENSEN . <br /> PROJEtl 11DDRESS � <br /> I�1�F��N 11� <br /> PIUMlI 0 MECHANICAL — <br /> FEE NO. TYPE OF EOUIPMENT FEE <br /> NO. TYVE OF FI%TURE (� UO <br /> ^ AIR COND.UNITS-M.P.EA <br /> 2 WAIERCLOSET TOILEn _ <br /> REFRI6ERAlION UNI15-H.P.EA <br /> � B�iHTUB "' BOILERS-H.P.EA. <br /> 2 LAYATOPY WASH BASINI <br /> � � OAS FIRED AC.UNITS-TONNAOE EA <br /> . SHOWER �- - FORCED AIR SYSTEMS-B.T.U. M EA <br /> KITCHEN 91NK8 DISP. _ W��� ��������� .���� M _ . <br /> � UI911W�911C11 __ - " ' ' '_ _ <br /> UNIi HEATERS-B.T.U. M <br /> � � LAUNORYiRAY Eypppq�TIVECOOLEHS — <br /> ClO1HE8 W�9HEH CL07HE5 DRVERS — <br /> - R VENTIUTION FAN <br /> -- UN�NAL / qANOE HOOD - �' <br /> — ORINKINO FOUNTAIN - I11R H�NDLINO UNIT- C.F.M. — -- <br /> � FIOOR DRAIN STOVE —' <br /> ' - VIICUUM BFE�NER9 _ METAL FIREfUCE 8 CHIMNEV — <br /> � ROOF OM�N9-R�INLEADERS .� WOOOSTOVE/FIREPIACE INSERT <br /> - SINK SERVICE-BAR.ETC. ��Ah� H��k,t �_ <br /> SUBiOTAL S <br /> 9UB TOT11L �d pENMIT � <br /> PENMIT � TOTAL FEE f <br /> TOTAIFEE � <br /> THIS PORTION TO BF COMPLETED BY BUILDING DEPT. PERSONNEL`EE <br /> - P��NCNECKNU�BER � <br /> fRONtlETB�C1{ RE��SEIB�GI( SIDE9ETB�CN `EE EGEIPiNO <br /> o � an '• 6' �3S <br /> USE 20NE �`� 10111PE� y��.NT SIfE FE[! V1ILUATION FEE <br /> a� QQ� � �QE9 ONO � <br /> � <br /> T'PEOiCON91 OGCUP�NCYGIIOUP NO.OFOWE�;INOUNIfS _�/ � `T <br /> �-N R- 3 � BUILOINO s.7 1 ��• V <br /> sitc ov e�oa. Bo.or s�onies � M�x occ�oeo �� <br /> 1 /,L �. w PLUMBIN� <br /> q5 « ,�. � <br /> MECN�NICA1. <br /> FIRE SPPINKLEAS FIEOUIRED O YES Il�NO OTHER <br /> l��p�f�/' PENALTY � — <br /> 11PPUC�IIONACCBY FL�N9C��EQtEOBY �PPO.i0R195U�NCEBY 1 <br /> TOTAL <br /> / �— <br /> � Z��rJI <br /> �A. _ .:.�+.,.wlWrwW�++t.•�1„bM"��...S�r-�. ..�. . - . . ' . " . <br /> LY� <br />