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. .PPLICATION FO._ <br /> '°.`""`..° CO N STR U CT I O N everelt <br /> urv oc <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION �COMBINATION ❑ BUILDING � " /O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEP M�ILADONE59 = CItY 21P PNOM1E <br /> i <br /> iji...,�z � owG �/iUd �=:.,,�/%f•� l,�. ��4� � '� '3Yd' -dzd'J' <br /> ARGNIIEGTORpESIGNEP MAL�pDPE55 j� CIIY ZIP PIIONE <br /> / <br /> G/E�NER�LCONIR�CtOB MAILApONES$/ � GItY _>IP PHONC UG@NSE• <br /> l � r,���n�i�, 1�.�.s `>�/o:l le�.-..,,�� ..��r �,� %J'2 u3 .3 >'�:2JJ' �.(.,� 1 C'/�/.1�/7 <br /> MECIUNIGLC NiR�GiOq MRiL�00RE55 Cltt ZIP P�.ONE UCFNSE• <br /> PLUMBINOCONiF4G10R IMIL�DOPE53 CITY 21P FION[ �I[ENSE• <br /> CL�SS Of wOPtt <br /> �� NEW ❑ ADDITfON ❑ ALTERATION ❑ REPAIF ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEFi ❑ BUILDING RELOCATION <br /> �VA ATIONOfWOPe�COSiOfM�i�E111�14 NSl BORI <br /> Qi9�-�s�a'.� �� l,r-��YQQ�- � <br /> OESCNieE WONIt — <br /> USF OF BUILOINO � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> �` �- PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> IEO�L0E5CNIP110ilOFPROVENri�S wr+etto OR�TT�CNFO cories� PROVISIONSOFLAWSANDORUINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLElED WITH WHETHER SPECIFIED HERE• <br /> ior_e�ocK—ov " IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUfHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATUREO CONiRACTORORAU7H RIZEDA.ENT OATE <br /> i <br /> i <br /> 2 Q.�I2 � . �� X . . . � / � -. - . '-r�"l� <br /> PROJEGT�D�AE59 �PPLIC� SCITYBUSINF,SSLICE ENO. <br /> C L V U <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TUHE FEE NO. 7YPE OF EOUIPMENT FEE <br /> WA7ERCLOSET�TOILEp U' [XJ AIfiCOND.UNITS–H.P.EA. <br /> BATHiUB REFRIGERATION UNITS–fI.P.EA. <br /> � LAVATORY WASH BASIN� (�a OO BOILERS–H.P.EA. <br /> SHOWER Q� GAS FIRED AC.UNITS–TDNNAGE E0. <br /> l NITCHEN SINKB DISP. FORCED AIR SYSTEMS–B.T.U. M EA. <br /> y DISHWASHER WALL HEATERS–B.7.U. M <br /> LAl1NDRYTRAV UNIiHEATERS–B.T.U. M <br /> CLOTHES WASMER EVAPORATIVECOOLERS <br /> WATER HEATER CLOTHES ORYERS <br /> URINAL VENTILATION FAN (y <br /> DRINNINO FOUNTAIN RANGE HOOD �,� <br /> FI.00R�RAIN AIR NFNDLING UNIT– C.F.M. <br /> VACUUM BREAKERS SiOVE <br /> ROOF DRAINS–RAINLEADERS METAL FIREPLACE 8 CMIMNEY �i <br /> SINK�SERVICE–BAR.ETC. WOODSTOVE/FIPEPI.ACE INSERT I <br /> �d 7 � — I <br /> SUBTOTAL I� 9U9TOTAL f � <br /> PEHMIT 3 PEflMIT ! <br /> _ TOTAL FEE f TOTAL FEE S SZ� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> IRONi5EI011CN OEIIRSE�JI�B��CK SIOESEIO�CN PL��NCHjECRNOM9EN PL4NC�IECnIEE ' <br /> � :)O' T/ � , � ` V!d /���/ iEE fy`�•S� PE c NO � <br /> USE 20NE LOT ARE� ��J i <br /> V�C�Ni517E FEES VALU�TION F[E <br /> R'J IJ�OOU CeES ONO I <br /> TYPEOFCON51. OCCUP�NCYGROIIP NO.OFOWELlINOUNITS <br /> SRE OF BL00.� NO.OF S�IESJ M�%�G 10�D BUILDING 5 �Z� �) 4 <br /> Nw.i I <br /> /�// / PLUMOINQ .t�U <br /> J � (J <br /> MECHFNICAI /7 �\ <br /> FIRE SPRINKLERS REOUIRED ❑YES ❑NO <br /> G ��� <br /> OTHER rJ <br /> PENAITY �� � <br /> APPIIC�IION�CQOV PL�NSCNECNWBY �PPRFORISSURNGEBY <br /> TOT�L �-�" � <br /> ��� �'7� � ' G' syy. �� <br />