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APPLICA,��ION FC�F� �ONSTRIi�''TION <br /> PE�iM�T � <br /> Ihr[v�r9reen p�PrPU � <br /> CITV OF � <br /> everet� <br /> BUILDING DEPARTtdENT E�C F C: � �/C-"%'�-�, <br /> 259•eB10 TO 13E COMPLETED IN INK— PLEASE PRINT i <br /> U1':4[R AIAILAOD�E55 CI1V tiP P��ONL I <br /> �o,f(.�Jf�r /!/o�Tl��rs i�o.tisi. lnic. �72�C��5_�-�L��2<-rT4�2a8-- �3�-7i�'3 <br /> 7���i�� MAILPppF[SS CiiT ZIP PHONE <br /> I <br /> H n9CMrtEG10R0E51GNER M�t�A00RE55 C4Y ZIP PNONE �� <br /> S ��� <br /> ��H �:e:�i�i:df0'ItFAGI� AUIL�.]OFESS GITY 21P PHONE UGENSE• Ir <br /> ,o�x <br /> ,. H ..- _ -- � <br /> 9yy �..,.UNIG�CONfNnCTOR MAIIADURE55 CIIY ZIP �NONE LICHISF ' ' <br /> y �~ 4�LlnIBINOGONiR�CtON MAII�DORE55 GtY 21P PHONE VLCN>�e ' <br /> F!i �j � <br /> M9`.b <br /> � .'C� <br /> �'� I��v CLA55 F WONK <br /> N H <br /> NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOUI:STOVE/FPPLINSERT ❑ BUILOINGRELOC4TION <br /> � x tINANt IMPPOVEMENL OR INiENIOR PEMO�EL ONLY CONiACT PERSON AN�PIIONE NO n <br /> y b GONLRACTPRILEOF\VOPIt .C.(�f r �J ��O � `� ��— � <br /> 0[SCRIBEWONKANp50V�4EFOOTAGE�NVOWED /'{OAf C V ��F�LC <br /> ��g �� rZ .rF 33 - Ioc, 3 >37—?��� � , <br /> H �q! r�norosEo use or BuaoiNo I HEREBV CERiIFY'HAT I HAVE READ AND E%AMINED THIS APPLICATION AND <br /> ay�,i /�u/L� J--, �i KNOWTHESAh1ETO8ETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND � i <br /> �'� ORDINANCES GOVERNING THIS IYPE OF WORK WILL BE COMPLETED WITH <br /> r Hy IEGNl0E5LRIPiIONUFPROPENTYISNOWNBELOWORFTTPLNFOURCOPIE51 �yHETHERSPECIFIEDHEREINORNOT.THEGRANTINGOFAPEFMITDOESNOT . <br /> � � PFESU�dETOGNEAUTHORITVTOVIOLATEOFCANCELTHEPROV1510NSOf <br /> �,� �pr B�Ocrc o� ANVOTHERSTAT[ORLOCALLAI'JREGULATINGCONSTRUCiIONORTHEPER� <br /> n���---!!! d y q /J q FORAIANCE OF CpNSTRUCTIpN.THAT I AM AUTHOFIZED BY THE JWNER OF <br /> � �tr _�J � L��C yLGlI.�L' � GLL' N _ AND I COMPLVTW THRiOEM1STATE CONTRACTJOHSHLAWL1B2T7�RCWMANb ., . <br /> C+'1 � 296200 W�1C. <br /> 7i H V7 /� SIGNPiJFEOFCO4iF5C10ROli:.U➢�ORIZE�AGENi �NiE� '�I7� � Z I <br /> H O(n ! � r�._;'__ ir �tpG'—.y��� ! <br /> O ` X �� v!- <br /> /�. 1 <br /> PROJEGTRD�PE55 qPVL�LHNi5CI1Y8U5M[SSLiCEH55 FND�USINESSNFbIE ' <br /> �C � � g/� �' �'� -r,v .�z. CC2r(�T w. �_o u�>": 'LO 2 2 <br /> � PLUMBING MECHANICAL . <br /> N�/. 7YPE OF FI%TURE OH ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> NJATERCLOSET�TO�LETI /r � P1C—A/HNOLGUNITS—H.P. ____ _, <br /> s.� — <br /> ' ' � BATHTUB _�/Z'____ FORCED AIR SVP fE�dS—BT.0 �1 EA ___ _ <br /> � LAVATORY(WASHBASIN) - UNITHEATERS—B.TL. M <br /> � SNOWER /J _ CLOTMESDRYERS _ <br /> 'm �� KITCHEN SI4K3 DISP. /' � VENTILATION FAN � <br /> y.�! / DISHWASHER S _ RAhGE HOOD <br /> LAUNDRVTRf�Y � WATERHEATER _ <br /> Cl01HES WASHER WOOD STOVE <br /> f� o _ M1IETAL FIREPLACE 8 CHIMNEV <br /> URINAL <br /> � � DRINKINGFOUNTAIN FIREPLACEINSERT _ ' <br /> FLOOR ORAIN HEAT PUMP <br /> s BACKFLOW PREVEN7ER5 GAS PIPING <br /> ''�' ROOF DRAINS—RAINLEAOERS _ E%HFUST FAN _ _ <br /> SINK�SEFVICE—BAR.ETC 1 — <br /> ,,] J <br /> ��n <br /> �wV�' <br /> ��I^ SU9TOTAL 5 D __ ____--SUBTO7AL 5 __Lr{> (i__J <br /> PERMIT 5 '_ __ ___ __ PERMIT __ 5 _ _ <br /> TOTAL FEE S '�D TOTAL FEE S <br /> IRONTSEidALN PEP115EIfMGN SIpE5El0ACF PUINLHECRNUMBEf1 FEEi/a/ �5 PECEIP�NO. <br /> � O .2 D 3 S?o,3 3is; �' � (� 3�G j, <br /> usaorv[ LOL�PEA = ��l��+rsrte FEES VALUATION FEE <br /> YVES ❑ NO <br /> tta�or+s� occu�cvcAouP NOOFOWELLINGUNIIS B�!IDING y���� __�2 G_C� <br /> niwH�eo�v Cilia �� M 1 PWMBING �D — <br /> ,.�/ —�_— .—_— _ <br /> S.EOF UGI t+o.ovsioni[s usmt oCcioao MECHANICAL <br /> � � C]Y , //�y ! <br /> N /l�!1 7 <br /> �t7 MEiGHTlIMIiAiION OTHER � ( p ���� � .r]�] <br /> �7 a� j . � ' / <br /> nn�s�anwk��Rsn�Eomaeo�ores No STATEBUILDINGSURCNARGE y �(� <br /> STATEENERGYSURCHARGE _ I <br /> n6vucauonnCC m nnHSnopp or PUBLIC WORKS o�(� (J'� <br /> 3�z�1� ��✓1 rora� � '1 D,f I <br />