Laserfiche WebLink
fMEnrp+�M �PL�ATION FO�� � ���,�„ <br /> �m� CONS7RUCTION e <br /> everett �� P�RMIT <br /> TO DE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745� 1 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER ' MAI UPE53 Cltt 21P PHONE <br /> ���.� J��`� ��w ��� � ��. — I l G� <br /> �ARGH�TEGTOROE810NEN � �AUDAE53 Gm ZIi` vHONE <br /> ' -��3- <br /> GONT TOfl M�ILADOPES4 IIY ZIP PNONE NSE• <br /> ��S�c'e� ,�3 0 7-/3`(4��SC' �-e 9gi90 ��3'^ � � `{1 <br /> MEGN�WICALC4NTRAGTOR M�ILAOOPESS CI1Y 21P PHONE UCENSE• <br /> ,, * . <br /> • <br /> PLUMBINOCONTMCT011 MAILAODHE55 , GIfY ZIP PMONE LICENSE• <br /> CL�590F WORK y <br /> �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ WOODSTOVEIFqPL.INSERT ❑ BUIIDING RELOCAiION 6 <br /> �3 <br /> �U�TIONOFW0111(�CASTDFM�TERIALSFLUSU NI � H <br /> � 3lp ' <br /> •�� [*] <br /> DE9CRIB WORK \ . <br /> C�N�✓ G S ttis L <br /> use euaouw t�.i — L.`{ P <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AR <br /> PLICATIONANDKNOWTHESAMETOBETFUEANDCORRECT.ALL H H <br /> �au.oe RIPTIONOFGqOPERTY��MOWNBELOWOR �CIFOU,COPIE� PROVISIONSOFLAWSANDOFDINANCESGOVERNINGTHISTYPE '� 'T� <br /> �.�y OFWORKWILL'BECOMPLETEDWITHWHETHERSPECIFIEDHERE- ri � <br /> �oT e�oc��or b INORNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO � <br /> � GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK � <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTR,UCTION <br /> � OR THE PERFORMANCE OF CONSTRUCTION. A y <br /> 1 • � SION U OF CONTRACTOR OR AUTMORIZED AGENT DATE �/ �O� 17 <br /> �r ��� (r { �•S/ " - �.(�" /"� � N <br /> PROJECTADOBE53 �/ APPLIG NTSCIiYBU5ME55LILFNSENO. � Z <br /> lZ0 � . �/�IZ! 1Lldt� H � <br /> PLUMBINO MECHANICAL � N <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSEi TOILE AIR COND.UNITS—H.P.EA. "�+] <br /> BATHTUB REFRIGERATION UNITS—H.P.EA. <br /> UVATORY WASH BASIN BOILERS—H.P.EA. ' �� <br /> - SMOWEfl GAS FIRED AC.UNITS—TONNAGE EA � <br /> KITCHEN SINKd DISP. FORCED AIR SYSTEMS—B.T.U. M EA <br /> D13MWASHER O WALL MEATERS—B.T.V. M � <br /> UUNORVTRAY UNITHEATERS—B.T.U. M (((��� <br /> CLOTHES WASHER OD EVAPORATIVE COOLERS � <br /> WATER MEATER O CLOTHES DRVERS <br /> URINAL VENTILATION FqN O <br /> DRINKINO FOUNTAIN FANGE HOOD � <br /> FLOOq DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREANEHS STOVE � <br /> ROOF OMINS—RAINLEADERS MEiAI FIREPLACE 8 CNIMNEY <br /> H <br /> SINK SERVICE—BAR ETC. WOODSiOVE/FIREPLACE�NSERT (/7 <br /> . H <br /> N <br /> . � <br /> � BUBTOTAL SUBTOTRL f � <br /> � PERMIT t PERMIT f <br /> TOTALFEE 1 TOTALFEE 3 v <br /> TH�S PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FPONT9ETBGGK PEARSETB�CN S�OESETBACK PLANCHECKNUMOEf1 pP�I�NCNF.CMiEE <br /> 5 F �� `—^�O FEE D� /� PECEIPT NO. O <br /> USEZONE LOTANEA VACn IE J v <br /> � l �NO FEES V�LU�TIO:1 � fEE <br /> ttPEOFCON9T. OCCU✓ANCYCNOUP , ND.OFDIVELLINOUNITS � <br /> y_�. ,... , , . .R3 , i <br /> BUILOING S3 � /Z <br /> BRE OF BlD6-. � ' �•� NO:OF 970RIES M�X OCQ L �D <br /> q�� .f'f ' � PLUMOIN(i ¢ �� <br /> �• <br /> �� MECMRNICAI <br /> FIRE SPRINKLERS REOUIRED ❑YES O NO <br /> OTHER <br /> PENALTY <br /> APPLIC�TION ACC.BY PUNS CHEGRED BY APvq.FOR 165U�NCE BY - <br /> Ta.•� 24� <br /> ��3 1�-tArrr) L •G. <br />