Laserfiche WebLink
, ,iz.4�. [ <br /> '�,e`u;:, ' <br /> �PPLICATION FC� <br /> � '"'`"'°""' CONSTRUCT�ION . ' `°°'°" <br /> ; °n'!°r ' ;` ,� ^'. �", <br /> � .everett ." PERMIT . " . e . <br /> BUILDING DEPARTMENT <br /> 269-8745 TO BE COMPLETED IN INK• PLEASE PRINT I <br /> i <br /> ❑ DEMOLITION . ; '" C7 COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING O SIGN � <br /> OWNER , M �D�REHS GTY ZIP PMONE �. <br /> ��`.rirn � S3 o7- /3q rvuP S �'; o�w `I'�'24o S��S'�-93y�:� ', <br /> MCMITECTOROESIONER M�IL�DDNE54 Cltt 21P PNONE . � <br /> OENEML�,LqNTMGTOR ` MAILA�ORE55 Cltt ZIP � PIIONE LICENSE• + <br /> ,�. �,.l`� 1^��I dJ0 P 'S3 e 7-�39ativS�: �ue 1�-,-�e�R�Wu.p� 99 i4o-564�5Y'�z-�z1—o/t�1gRBc���c� <br /> MELM�NIG�LCONTR�GT�A , ��� MAIL�DURE99 �n' - 21P PHONE LICEN9E• <br /> l „�- <br /> VIUMlINOCONTMCTOR , MAIL�DORESS , � CITY ZIP PIIONE LICENSE• <br /> l Oi WONK <br /> NEW ❑ AODITION ❑ ALTERATION� ❑ REPAIR ❑ DEMOLITION O, WOODSTOVE/FRPI..INSERT ❑ BUILDINO REIOCATiON <br /> �T�TIONOFWORKIC04fOiM�TERULSPL�U80�/� ,n <br /> „ .,�. _.�.. �rx <br /> ���, � <br /> 0[OCRIlE ORK ' � , . � ' . J . . . � o ' .. ..1.� <br /> UlEOFlIIIIDIN I HEREBY CERTIPY THAT I HAVE READ AND EXAMINED THIS AP <br /> PLICATION AND KNOW THE SAMETO BE TRUEANDCORRECT,AlL <br /> IEOALDf9CRIPTIONOFPpOPERTY�B OWNBELOWONATi�CNiOURCOPIEW pROVIS10N50FLAWSANDORDINANCESQOVERNIN6THISTYPE <br /> �/ � OF WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HERE- <br /> �orJ1—e�oc�c.—_or IN OR NOT.THE GRANTING OFA PERMITDOES NOT PRESUME TO <br /> GIVE AUTIiORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> , � , , �, � OR THE PERFORMANCE OF CONSTRUCTION. Q� <br /> � �� ' SIO RE OF CONTRACTOR OH AUTHORIZED AOENT OATE �21�/V � <br /> L � "�V _ �-�' <br /> IRO�ECT ADDRE88 APPLIC�NTS Cltt BUSINE55 4CENSE N0. <br /> I 4 <br /> PLUMBINO MECHANICAL ' <br /> N0. TYPE OF FI%TUNE FEE NO. TYPE OF EOUIPMENT � � FEE <br /> WATEF CLOSET TOtLE AIR COND.UNITS—H.P.EA <br /> BATHTUB EFRIGEPA710N UNITS—H.P.E0. ' � <br /> I LAVATORV WASN BASIN� BOILERS—H.P.EA <br /> SHOWER O�S FIRED AC. UNITS—TONNAGE EA <br /> KITCHEN SINKB DISP. FOFCED AIR SVS7EMS—B.T.U. M EA � <br /> DISHWASHER HEATERS—B.T.U. M <br /> UUNORVTRAY UNITHEATERS—B.T.U. M• <br /> CLOTME9 WA9HER EVAPOMTWE COCLERS <br /> WATER HEATER CLOTHES DRVERS <br /> URINAL � �ENTILAiION FAN <br /> DRINKIN6 FOUNTAIN RANGE HOOD <br /> � FLOOR DRAIN AIR HANDLING UNIT- 0.F.M. <br /> � VACUUM BREA ERS STOVE <br /> i ROOF DMIN RAINLEADER9 METAL FIREPLACE 8 CHIMNEV <br /> 91NK 9ERVICE-BAR ETC. WOODSTOVE/FIREPLACE INSER7 <br /> � ' <br /> � <br /> � <br /> i * BUBTOTAL SUBTOTAL f � <br /> PERMIT { PERMIT t <br /> I � TOTALFEE { TOTALFEE f <br /> i THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> � � <br /> I IRONT 9ETBACN REAP SETBACK 910E BETBACN PI�N GHECK NUMBER PL�N CMECN FEE <br /> 2O �Q + � f /L/ Y� FEEI /10 y� REC L�IIJ^ <br /> USE20NE LOT�REA yACANT5IT[ <br /> � ��rZ � 3oG � OYES•ONO FEES V1ILUATION FEE <br /> NPEOFC OCLUPANCYGROUP, NO.OFOWELLINOONRS ' O <br /> ^/" +� / BUILUINQ • S � . • • <br /> � &2E Oi BLDQ NO.OF 9TORIE3 M�X OGG IO�D <br /> PLUMBINO <br /> i <br /> � MECH�NI�L � <br /> � FIRE SPRINKLERS REOUIRED �VES ❑NO <br /> 1 OTHER <br /> PENALTY <br /> I APPLICAiION�GC.BY PlAN9 CMECI(EO BY APPR.FOR ISSUANCE BY <br /> I TOTAL (,� <br /> � JoC , i� • � ' G � �� • `�� <br /> � �G . �( <br /> I � ��9 <br /> � ...__... .......... .......,�._�..�. ,...._..�._, ... _...,. . . . _... _._ _„_,,. ,__ <br />