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,h.Ewro�.� . ArPLICATION FOR ���,�„ <br /> �TM�F CONSTRUC�'ION � <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER � M�ILAUOPESS CITY 21P PNONE <br /> C/c�AJ M�//� �. �OOG Ma�/e al ��r�«<�7 ..�_,— <br /> AqLNITEGTOR0E510NER MAILIIDORE39 Cltt 21P PNONE �-�T- <br /> Tv/u f3�kn�v ,2�y2 9. 11'f �sE� .i�aTi,l G r�Fv:Ti �,in •c� c y� <br /> OENER�IGONTR�CiOR MI1IL11DORE39 CIIY 21P FNONE LICENSE• <br /> Th�J /,iaeon/ ..".i�{,t9 -1R93E ,.fee3,1�� ���' 1 �:?"-�W�1•= J�1rJ!h1��iKr�' <br /> MEGH�NIC�LCONTMCTOq M�ILADDRES9 CITY 21P J PMONE LICENSE• <br /> � <br /> 71VM81NOCONTMGTOR MAI�ADDNESS CITY ZIP PNONE LICENSE• I <br /> CL�SS OF Y/OPK <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSEqt ❑ BUILDING RELOCATION <br /> V�LUATION WORK�COSiOFMA7EBIAl$VLUSL�BOip � _ <br /> �3�3Go �i�.�e j�ious�ua� r,'v�,i f�«,u���d v�+/%���. <br /> OESCRiBE WOMY. � <br /> USE Oi BUIlDINO <br /> ��h v ,� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> � PLICATIONAND KNOW THE SAME TO BETRUEANDCORRECT.ALL <br /> LE6�lDE3CRIPTIONOFPROPERTY�9MOWNBEIOWOFATTACNFOURCOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or�e�oc�—or IN OR NOT.THE GRANTING OFA PERMIt DOES NOT PFESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANI:EL THE PROVIS!ONS OK <br /> f�'�' a0 %cV/� ,i� iPCN U�� ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCTION <br /> O I i -% / �G �JJ�9 �T N •a ,��,2�f /'pa n � OR THE PERFQRMANCE OF CONSTRUCTION. (� <br /> DO} N� Yy N�'✓/ d�/�' rN4j�Jr�/ r6�lU 120� gipN�TUREOFC6JlTR�CTORORRUTMORIZEDAGENI DAiE •� �7 -VG <br /> � ) L ���, e i9eF7' Te r�ai7. > <br /> X/���{ . . � -!,'�r� <br /> VR0.IECT�ODPES! AFPrfCANT3 CITY BUSMESS UCENSE N0. <br /> �f CS�i 'it'l3�/C �'�lCrPl c�/asf� � <br /> PLUMBINO MECHANICAL <br /> NO. 7YPE OF FIRTUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WIITER CLOSET(TOtLE AIR COND.UNtTS—H.P.EA. <br /> B/1THTUB REFRIOERATION UNITS-H.P.EA <br /> LAV�TORY 'NASM BASI BOILERS-M.P.EA. <br /> SHOWER GAS FIRED AC.UNITS-TONNAGE EA <br /> KIiClIEN SINK 6 DISP. FORCEO AIR SYSTEMS-B.T.U. M EA. <br /> DISHWASHER WALLHEATF.RS-B.i.U. M _ <br /> L�UNDFVTNAY UNITHEATERS-B.T.U. M <br /> CLOTHES WASHEF EVAPOHATIVE COOLERS , � <br /> WATER HEATER CLOTHES�RYERS <br /> UNIN�L VENiILATION FAN <br /> DHIHKINO FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HnNDIING UN�T- C.F.M. <br /> VACUUM BREAKEFS STOVE <br /> ROOF DRAINS-HAINLEAOERS METAI FIREPLACE 8 CHIMNEV <br /> SINK $ERVICE-BAR ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUBTOTAL SUDTOTAI f <br /> PERMIT t PERMIT ! <br /> TOTALFEE • TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNF� <br /> iPONi SETB�CN REAR SETBAGR SIOE SETB�LK PUN GNECN N MBER PUN LNECN FEE <br /> z.� zo S ` �Co�j3 FEE�.1 ��� y S <br /> USE 20NE l0T�REA y�CANT SITE <br /> �i� /� S� OYES �10 FEEB V�LUATION FEE <br /> iYPEOICONST._ , OCGUPANCYGROUP NO.OFUWELUNOUNIT9 <br /> g ' N'1 0 <br /> 'r am�ou+o si �� � _ S`1 <br /> 312E Of ByDO �� NO.OF S�PIE9 . M�%.00C.LOAO <br /> YQ d ^"� PLUMOINO <br /> MECNANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES NO <br /> OTHER <br /> PENALTY <br /> �PPLIC�TION ACG.BY FUNS CXECNE�BY �PPR.FOR ISSUANCE BY TOT�L 4-¢ J <br /> S7�' J� ' <br /> c_. . G . � �� <br /> �� <br />