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�ME�ro�.� �tAPP'LICATION FOt� �Y�,�„ <br /> �maf CONSTRUCTION � <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDING GEPT. ,�,( <br /> 258•8745 ❑ COMBINATION I� BUILDINQ ❑ MECHANICAL ❑ PLUMBIN(3 ❑ SI(iN <br /> OWNER M�IL�DORESS Cltt 21P PNONE <br /> �Z� �� I'IT.1J (�%(' �'r�. ��a- �«�.r�- Pri-►fE��- ��h.�i'1- �71�7c���.o <br /> MLNITECTONDESI6NER MAIL�UURESS Cltt ZIP PIIONE <br /> L'!�'tU� — <br /> OENEMLCONTR�CTOH MMLAODPES3 Gltt 21P PNONE 4LENSE• <br /> $A-,��� �IGzfIC.#' I(�.�NG <br /> MECH�NICALGONTMCiOfl MAILAOORE59 CITY 21P PHONE LICENSE• <br /> �.�■1Y'/Y��� x�PGI�..G'' <br /> PIUMBINy GONTPAGTOH Il M�LL AODFE53 Gltt Z�P PNONE LICENSE• <br /> l�pr S�.LFL�1��G' <br /> CL11990F WORK <br /> � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOI.ITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N <br /> VQU�TIONOFWORK�C09TOPMATE Ul9PLU9L�B01ry �b <br /> tl �2;t'�'B`'� ���Z, Ot�O . <br /> DE9CRIBE WOPK � 1 j � ' <br /> NE1IJ L�'N��IR���IlC.1J . -(i�N(�,E- - �W V <br /> useo(vaw�owo <br /> � Y �� �I I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> J,IJ�7L'G'- �hYf��1� � L�NI.�� PLICATIONANDKNOWTHESAME .7BETRUEANDCORRECT.ALL <br /> IEO�lDf.3CHIPTqNOf ROPENTY�S OWNBEIOWOR�TTACHFOIIRCOP1E51 pROVI510NSOFLAWSANDORD��JANCESGOVERNINGTHiSTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �ot e�oc�or INORNOT.THEGFANTINGOFAPERMITDOESNOTPRESUMETO <br /> /^ vN ��� GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF <br /> V ANYOTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> k1�/_r�, ON� �7� � SIGNATU EOFCO T CTORORAUTHORI2EDAGENi DA7E <br /> � wrv� <br /> L.� 3lC' 2-l� �1- X !� c2 � <br /> PNOJECT�DORE39 ���L�C�NTSClttBU51 SIICENSENO. <br /> �txt�+to►� � <br /> PLUMBINO MECHANICAL � � <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EGUIPMENT FEE <br /> W�TF.R CLOSET TOILE7) AIR COND.UNITS—H.P.EA <br /> BhTHTUB flEFRIGERATION UNITS—H.P.E.l__ <br /> LAV�TORY�WAaN BASIN) � BOIlERS—H.P.E0. <br /> .�,^'� SHOWER OAS FIRED 0.C.UN�TS—TONNAGE EA <br /> KITCHEN SINK 8 DISP. � � � ORCED AIR SYS7EMS—B.T.U. M E0. OO <br /> DISHWASHER WALIHEATEf75—B.T.U. M <br /> LAUNORYTRFY UNITH[ATERS—O.T.U. M <br /> CLOTHES WASHER EVAPORA7IVECOOLERS <br /> WATERf/EATER CLOTHES�RYERS <br /> URINAL� 3 VENTIIAiION FAN Q� <br /> URINKINO FOUNTAIN RANGE HO(1D _ <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF ORAINS—RAINLEADERS METAL FIREPLACE d CHIMNEY O <br /> SINK SERVICE—BAq,EiC. WOO�SiOYE/FIREPLACEINSERT <br /> SUBTOTAL SUB TOTAL 3 <br /> PERMIT 3 PENMIT 3 <br /> TOTALFEE 3 TOTALfEE f _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FNONT/SEJI�B�L�K �} BEAR SEtB�CK � SIDE SEiBACK PUN G'I�GN NU�d6ER/ ttFN CIIECK FEE <br /> GJr7� 1 ��� 1 � �J E�o7�� � RECEIP/�oO(O� <br /> USE 20Nf. l0f�RE�a��` y{� VACRNT SITE <br /> , ��� ��'Iu�(a�Cl `�'I [MS ONO FEE9 ���UATION FEE <br /> \..J�/L/ <br /> TYPF.UFCONST. OCCUP�NGYGPOUP NOAFOWElUN0UNp5 <br /> `�— � }Z 7J, �� � � - evi�oiNa � � s CJ � =J� �0 <br /> size ov aioo No.oF sromes M�x occ�oeo <br /> R3= 21�47 S.F. 2 t fjSMT PJ r�.ur,�aiNc _ �j <br /> M = 4nc _ <br /> • MECIIAVICAL �� <br /> FIRE SPRINKLERS FEOUIREO ❑ YES NO <br /> OTHER <br /> PENALTV <br /> 11PFUC�TION�CC.BY PUNS GHEGNEO BY �PPfl.fOR ISSU�NGE BY <br /> �� � `C . TOTAL <br /> 5 'I:]'UJ'11� - . <br />