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:�.�f� -� ��`� �PLICATION FO ''"` . <br /> ��«<� <br /> ``�E�°�^ � � � CONSTRUCTION <br /> Grr or � ' f <br /> everett ` PERMiT `E <br /> BUILDING DEPARTMENT TO BE COMPLETED IN INK• PLEASE PRINT f; <br /> : 259•8870 � <br />���O��UEMOLITION �COMBINATION f�Bl'ILDING ❑ MECHANICAL � ❑ PLUMBING � ❑SIGN � <br /> Cltt ZIV PMONE - ' V <br /> �.OWNER M�ILADDPE55 �� r <br /> .T ;i " � �nrCTbaN� � Gfllf�i IIAQbv�d r� EUFI7�iT Q82Q3 ��� t <br /> MGNITECT ON UEBIONEN <br /> M1ILAOONE55 Cn' 2iP PHONE � <br /> G�tt ZIP PHONE LIGENSE• F <br /> O[N RALCONTR�Gi <br /> M�ILAOURE53 � 1 <br /> LICENSE• � <br /> MEGM�NIG�LGONTR�CTOfl <br /> M�II�DORE55 G��Y ZIV PMONE , <br /> ! <br /> PLUMB�NOCONTP�CTOA . <br /> MML�ODRESS CiTY 2iF PNONE LICENSE� <br /> � <br /> GLA89 GF WORK �/5 <br /> ❑ NEW ❑ ADDITION �v ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOO�STOVE/FRPL.INSERT ❑ BUILDING AELOCATION i <br /> i <br /> VAL WTION OF WONN�C09N�M�TERI�LS PlUS L�90RI L <br /> v; �� f <br /> �D!lCIII�EWORK 11 C ��D�� � <br /> .J <br /> � uK of�ui�oiNo I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED Th'IS AP• � <br /> � � PLICATIONANDKNOWTHESAMETOBETRUEANDCORREGT.ALL y <br /> LEO�IDFlC11��TIONOFPPOPEPTYI9NOWNlELOWOR�TT�GNFOUNCOVIE51 OFWORK�WIL�LBECOMPLE EDDWITHWMET�HERSPECFEOCT�RE• A <br /> �oT1L��a�'�� GI EpAUTHOR TYTO VIO A�TE OR CANICEL�THE PROV SIONS OF � <br /> ANY OTHER STATE OR IOCAL LAW REGULATIN6CONSTFiUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. . � <br /> ' SIONATURE OF CONTR�CTOR OR AUTHOR12ED AGENT D�TE i <br /> t <br /> " # u4 F <br /> . � <br /> � �pp�IC�NiS CItY BUSINESS I�GENSE NO <br /> •►IqJECT1IDDRE88 1 <br /> � � <br /> .l, ., <br /> MECHANICAL <br /> PLUMlING FE! <br /> �� Np, TYPE OF EOUIVMENT <br /> NO. TYPE OF fl%TUN!OR ITEM NC—�/HN���UNIT9—M.V. <br /> � ��� WIITENCL04ETITOILET) REFRIGERATIONUNITS—N.P.EA. <br /> ,. ' s"TMTOe BOILERS—B.T.U./HP. <br /> � ��� LAVATORY IWAS/I B�SINI ' <br /> . 6A3 FIRED A.C.UNITS—B.T.U. <br /> �''� ��R FOPCEDAIR3YSTEMS—B.T.U. M�� <br /> � 1(ITCHEN SINK 6 DISP. M <br /> WALI HEATERS—B.T.U. <br /> D19HWASHER M <br /> UNIT HEAiERS—B.T.U. <br /> ' LAUNDRVTN�Y EVAPORATIVECOOLERS <br /> CIOTMES WASNER � <br /> CLOTMESORYERS <br /> URINAL yENTIUTION FAN <br /> DHINNINO FOUNTAIN RANOE HOOD <br /> FLOOR ONAIN � WATER HEATEti <br /> ' � BACNFIOW PNE�EMTEAg WOOD STOVE <br /> � � ROOFDPAINS—N�iNlEAOERS METPLFIREPLACE6CHIMNEY <br /> SINK ISERVICE—B�A.�C.) FINEPUCE INSERT <br /> MEATPUMP � <br /> � 6AS PIPINO 3 <br /> E%H�USTFAN E <br /> ',' ' SUo TOTAL ( <br /> . � fUlTOTAI s p�qMIT 1 <br /> PfRM1T f � <br /> ' f TOTALfEE � <br /> TOTAL FE! F� RECEIPT NO. <br /> %.AN I:NECK NUMBER � <br /> fRONTSETB�Gfl FEeRSEiB�CK SIDESETB�CM � <br /> ( <br /> LOtAFEA FEES VALUATION �E { <br /> U4E20NE V�C�NTSITE � � <br /> . OVES nr+o BUILDING S <br /> iYiEOFCON9T OCW7ANGYGROUP NO.OFDWELLINOUNIB <br /> - �- PIUMBING <br /> SRE OF BLOQ ' NO OF STORIES M�x.oGG.Lo�o MECMANICAL � <br /> 1 <br /> OTHER I <br /> FIRE SPRINKLERS FEOUIRED ❑VES ❑ NO STATE BUILDING SURCHARGE ; <br /> , � � SiATEENERGVSURCHARGE �� <br /> •PPLICAIION�CC BY PUNSCNECNEOBY �VPR.FORISSWNCEBY p�B1.ICWORKS ' <br /> TOTAL <br /> PROPERTY�NELOCATIONSA DNREUTEDEASEMENTISINGALL <br /> _ ..._.... .. ._.._ - - <br /> —,-.�.-:.�.......T... ' ..._ . _. <br /> .... .. ,�.. . <br /> ���.�.r�...-...,. _ _ _ - - <br />