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���,E�,,,,,, ��,PP�.ICATION FO� ���,�„ <br /> �� COh1STRUCTION <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �.MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNER M�IL�D�qE53 CITY 21P PNONE <br /> f3�Lr�,i.rcL L'�1o�10. ��I� �• 1'YlQa=tne lJi� Or. tUe».l� �&L01 25�-�1'73 �� <br /> ARGMITECTORDESIONER MAILAOORE55 CITY 21P PNONE <br /> OENERALCONTP�CTOR M�IL��ORE53 Cltt 21P PHONE UCENSE• <br /> CN�HIC�LCON CTOq M�IlA00RE55 CIfY 21P PHONE LICENSE• <br /> � �'�-�.►� s�5 ���� a��� a� -����- w� �-�� � �,����,- <br /> PLUMBINO TR� OR MM�A�ORE59 CIiY 21P PIIONE LICEN E� <br /> CU1880F WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIN6 RELOCATION <br /> VAIUATION OF WORI(�COST OF MATERI�L9 PLU9 L�BONI <br /> � � �-I 34�54' <br /> DEBGR BE WORN <br /> =Yl 0�.� n0.c Z Lv -�-C.V � = • <br /> uaeoF`aulrn+A I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> J r �� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LE011LDE8CRIPTIONOFPFOPERTY�9HOWNBELOWOR�ITACHFOUNCOPIE51 pROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISTYPE <br /> OF WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �or_s�oc�_ar IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> OIVE AUTHORITY TO"IOLATE OR CANCEL T71E PROVISIONS OK <br /> ANYOTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. � <br /> S16NATURE OF CONTRRC70R OR AUTHORI2E0 AOENT DATE <br /> ` � a� 7 <br /> PPOJECT�D�RE53 �PP�I NTS ITVBUSINESSUCENSENO. <br /> 131��� �i 1 l�r� -�IJeY'�e <br /> PLUMlINO MECMANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET TOILE qlR COND.UNITS—H.P.EA. <br /> BATMTUB REFRIGERATION UNITS—H.P.E0. <br /> LAVATORY WASH BA91N BOILERS—H.P.EA. <br /> SHOWER OAS FIFED 0.C.UNITS—TONNAOE EA <br /> KITCMEN SINKB 019P. FORCED AIR SVSTEMS—B.T.U!0�M EA. <br /> OISNWABHER WALL HE�TERS—B.T.U. M <br /> LAUNDRVTRIIY UNITHEATERS—B.i.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLEHS <br /> WATER HEATER CLOtMES DRVERS <br /> URINAL VENi1LATION FAN <br /> DRINKINO FOUNiAIN RANGE HOI.i <br /> FLOOR ORAIN AIR HANDLING UNIT— QF.M. <br /> VACUUM BREAKERS STOVE <br /> ROOFDIUINS—RMNLEADERS METALFIHEPLACEB CHIMNEV <br /> SINK SERVICE—BAR ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUBTOTAL SUBTOTAL i <br /> PERM�i ! PERMIT f <br /> TO7ALFEE ! TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONTSETB�CN FE�PSETB�CR SI�ESEfO�CK PLANCMECNNUMBER PUNCHECRFEE <br /> FEE RECEIPT NO. <br /> U9EZONE LOT�qEA y�CANTSITE <br /> Ol'ES ONO FEE! VALU�TION FEE <br /> TYPEOFCONST. OCCUPANCYGROUP NO.OFOWELLINOUNITS <br /> BUILOINO S <br /> 81ZEOFBL04 NO.OFSTORIE9 MA%.00C.LO�O <br /> PLUMBINO <br /> MECHIINICAL SO <br /> FIRE SPRINKLERS REOU�RED ❑VES 0 NO <br /> OTNER <br /> PENRLTY <br /> •PPLICATION ACC.BY PLAN9 GNECNEO BY APPR,FOR ISSU�NCE BY <br /> � TOT�L <br /> .t.. ' s'. . . . . . <br />