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'. �PPLICATION FO�. ' ���,�„ <br /> I�rEwqrNn CONSTRUCTION <br /> �iTM oF e <br /> everett PE RM IT <br /> BUILDING DEPARTMENT <br /> zs9•8�45 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNER M�IL�OORE39 CItY ZIP PNONE <br /> �,�#�,�'�c �jiJ --,Q�'Ii.�cN iaao wsxe�N; t c> 9�Fao1 �,��-so��/ <br /> •11CMIIECTOROESIONER MMI�UDRE39 Clrv ZIP VIIONE <br /> �Ydl- ,�ir02iC// G�a//3.�NONF �� 9r,3a3 �,�3-Y3d� <br /> OENEN�IGONfP�C70N MML��OFE59 C11Y ZIP PNONE 4CENSE• <br /> STA� JS�Jx+E�,oLd .�3/S� ..z''�'.9�1 ,S� ��� %��GS .3 S-�� Srir�/t8 <br /> MECNIINIGQCONfP�GTOq � M�IL�pDRE39 CIIY ZIP PIIONE UCENSE• <br /> FLUMBINOCONiR�GTOR M�IL�DDNE39 GIfY ZIP GIIONE IIGENSE• <br /> C11S50i WOR1c <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ DEMOLI(ION ❑ WOODSiOVEIFRPL.iNSERT ❑ BUILDING HELOCAI�ON <br /> V�lll�TION OF WOHN�COST OF MeIEqI�IS GLU9l�BOPo <br /> L7 VVVr Q—U <br /> OESCHIBE WON1c <br /> .T.J,i' � u i✓ .COu r.F/m�7 E.P O/= �S/Of/�LG� <br /> USEOF BUILDINO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• �� <br /> CS/OE�LL`- PLICATIONAND KNOW THE SAME 70 BE TRUEANDCORRECT.ALL <br /> LE6�LOESCRIPTIONOFPpOiEPTYISHOWNBELOWORATTICNFOIIqCOPIES7 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> 'a� OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �o�_e�x�l�Cor IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> /I,/� T � L ANYOTHER STATE OR OCAL LAW REGULA ING CONSTRUCTION <br /> EzJc�c/�� d /"� <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> /1 � � SION�iUREOFCONTR�CTORONAUiNOR�ZEDAOENT OATE <br /> �- //7_ � _a�o-D/o X ,C�e�c��-il. ��`��� <br /> PqpJECf�D�RESS ��PLI �NiSCIiYBU51NE53lICEN5EN0 • <br /> �O�D ?�T _ <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OP FIXTUNE FEE N0. TYPE OF F.OUIPMENT FEE <br /> WATEH CLOSET ITOILET) A�R COND.UNITS—H.P.EA. <br /> B�iHTUB � FEfRIGEPATION UNITS—H.P.E0. <br /> LAVATORYIWASH BASINI BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AG UNITS—TONNAGE EA. <br /> KITCHEN SINKB DISP. FORCEO AIR SYSTEMS—B,T.U. M EA. <br /> DISHWASNEH WALL HEATERS—B.T.U. M <br /> LAUNDRYTR�V UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HE�TER CLOTHESDRVERS <br /> URINAI VENTI�ATION FAN <br /> ONINKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN Alii HANDLING UNiT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF ORAINS—RAINlEA0ER9 METAL FIREPLACE 8 CHIMNEY <br /> SINK SERVICE—BAH,ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUB TOTAL S <br /> PERMIT i PERMIT S <br /> TOTALFEE ! TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fHONTSEIB�CN PE�RSEiBALK S�OESETB�CK PUNLNECKNUMBER PLANCI�ECKfEE <br /> FEE AEGEIPt NO <br /> USE ZONE LOi�REA y�CANT SITE <br /> OYES ONO FEES V�LU�TIOH FEE <br /> TYPEOFCONST. OCCUP�NLYGROUP IW.OF�WElUNOUNIT$ <br /> BUILDIN6 f <br /> 512EOfBlUO. NO.OFSI0PIE5 M�;OCu.LOAO <br /> PLUMBIN6 <br /> MECNANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES O NO <br /> oTHen <br /> PENALTV <br /> •PPUC�OON�CC.BY PL�NSLNECRE�BY APPR.FORISSWNCEBY — <br /> TOTAL <br />