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. .PPlI�CATION FO..' ����e„ <br /> '"'E""'"" CONSTRUCTION e <br /> cm or <br /> everett PERMIT <br /> BUILDING DEPARTMC�'T <br /> 259•8745 • TO aE COMPLETED IN INK- PLEASE PRINT <br /> �{DCMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWi�ER M�IL�UURE55 Cltt IIP PIIONE (� �J7 <br /> �ia��Ai,/v* eiG^� ,QG��7 /,t� rN f'� .L� �a�r�Jezt,ciw, `Id��/ <br /> �PGNilEC10R0E51GNEP ` M�IL�U PESS ` Clrv 21P PION[ <br /> /1/G/'/�l,jC'//'n� � /.l�'/�./�/IC.0 s .11�l.L�.L' <br /> LL.JL M�ILA�URE55 �� L}Y ZIP PIIONE IICENSE• <br /> OENEPALGON NAGiOR <br /> 'TiaRcu�T� ln i�t+'� , ;.�t i�dR �cc1' �[�� v3 <br /> MEGNIINIC�ICONIMGTOq MMLAOURE55 GITY 21P PNONE L�CE C_ <br /> PlUM81NOCONIR�CIOR MMIADORE55 GITV ZIP VIIONE �iCENSE� <br /> C1�5501 WOpK <br /> [� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR �DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> "\ <br /> V�L11:.�ION OF WORN�C04t Oi MAIERI�LS PLUS L�BOFI <br /> !J/�/]_.p� <br /> OESCA�BE WORK ' <br /> �vC � i �' d �'�,r vc�v, _ <br /> usE o�eunou+o I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS hP• <br /> PLICATION AND KNOW THE SAME TO BE TRU[AND CORRECT.ALL <br /> LEOALOESGA�PfIONOFPNOVERfY15HOWNBELOWOR�iT�CNFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHIS?'!PE <br /> ,� �.0 OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEOHERE• <br /> ior—e�cr.�_or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATUREOF RRCTORORAUiH�1R2E0AGENT D4TE ' <br /> X ' 7 ,, �n�z u�� �. <br /> APPLIC�N I YBlI5NE55LICEN5EN0 <br /> PPOJECT�DDRESS lC { <br /> ��� �'��iZW C �/I�¢✓ � <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH CIOSET ITOILEII AIR COND.UNITS-H.P.EA. _ <br /> BATHTUB REFRIGERATION UNITS-M.P.EA. __._ <br /> UVAfOHVIWASH B�SINI BOILERS-H.P.EA. __ ___ � <br /> SHOWER GAS FIRED AQ UNITS-TONNAGE EA I <br /> NIiCHEN SINK6 OISP. FORCED AIR SVSTEMS-B.T.U. M EA. I <br /> DISHWASHER WALLHEAiERS-B.T.U. M _ _ <br /> LAUNDRViR�Y UNITHEATERS-B.T.U. M _ <br /> CLOTHES WASHER EVAPORATIVE COOLERS _ I <br /> 'VATER HEAfER CLOTHES DRYERS _— <br /> UR�NAL VENTILATION FAN <br /> ORINKIN6 FOUNTAIN RANGE HpOD — <br /> FIOOR OR�IN P.IP HANOLING UNIT- C.F.M. _ <br /> V�CUUM BRE�NERS STOVE - , <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE 8 CHIMNEv � <br /> WOODSTOVE/FIREPLACEINSEFT � <br /> SIKK�SERVICE-B�R.ETC. I <br /> - I <br /> SUB TOTAL SUBTO7AL S _ <br /> PERMIT 3 PERMIT s <br /> TOTALFEE • TOTALrEE 3 � <br /> THIS PORTiON TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iPONi5E1BAGK REARSEIB�GR SIOESELB�CN PUNCHECKNUMBEB AUNCnEGKiCE <br /> iEE �ECEIPT NO <br /> WEiONE ����pE� WG�Ni51TE FEES VALU�TION FEE <br /> OYES ONO <br /> TYPEOfCONST. OCCUC�NGYGROUP NO.OFUWELlINOUNITS <br /> BUILUING f <br /> Si2E Oi BIDU. NO OF Si0RIE5 M�%OCG LO�D <br /> PLUMBING <br /> MECHANICAL <br /> FIRG SPRINKLERS REOUtRED ❑YES ❑ NO <br /> OTHER <br /> PENAITY _ <br /> �PVIICAiION�CC.OY �LANS GIIECRED BY �PPii.iOR ISSU�NCE BY <br /> TOTAI <br />