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'�y��.PPLICATION FO►:' ���,�„ <br /> I�sEr�rym� CnNSTRUCTION O <br /> an or <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PFINT <br /> ❑ DEMOLITION ❑ COMBIN.ITION ❑ BUILDING DQ MECHANICAL ❑ PLUMBINO ❑ SI(3N <br /> JWNFH M�IL�OORE55 CITY LIP PMONE <br /> ��q� �r ec-,Uo FrF •7?32 7'/��-�'� /=!)��e�i �'�3 3 �/7- °/i�z <br /> nLNlllCTOROFlipNfR � MAll�00RE98 CIiY 2P ONE <br /> :ENEMLGUNIB�CIOR� M�ILeUDRE55 Wtv 2�P PNONE L�f.ENSE� <br /> [+jJFPF_Ti �'!-(2G�C.?t . ab/Z GJF�6_OG't�I�GNS� �!/E�t)i� ��11J2 �53-371? _ <br /> �fCN�NIWtCONiR�CIOH MAIL�DOOE99 pfY LIP PNON[ ULENSE� <br /> 'LVMBiN6CONLPACIOR MAIt ADORESS C�TV ZIP ���ONE UCENS[• <br /> .USSOf WORN <br /> ❑ NEW ❑ IIDDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL.INSERT ❑ BUIL�ING RELOCATION <br /> �LW1�ON OF WORR�COST Of M�IERUL9 PLW IABORI <br /> ESCRIBEWOAN ' ^ .L <br /> �� l• 1 <br /> seoreunoina I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- � <br /> PLICATION AND KNOW 7HE SAMETO BETRUEANDCORRECT.ALL <br /> �O�lDESCRIPTIONOFPROPERIY�SHOWNBELOWO�Ait�CHFOURCOPIE51 PROVISIONSOFI.AWSANDORDINANCESGOVEqNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETfiER SPECIFIED HERE• <br /> Ji_BLOCIL_OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF' <br /> ANY OTHER STATE OR LOCAL LAW PEGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGIUTUREOFCONiRRCTOfiORAUTNORI2EDAGENT DAIE <br /> X � <br /> �OJECi�DOAE55 � �PPUG�NiS Li�v BU9NE59 LIGENSE NO. I <br /> � <br /> � G � <br /> I <br /> LUMBINO MECHANICAL <br /> NO. TYPE OF FfXTUPE FEE NO. TYPE OF EOIIIPMENT FEE <br /> WATER CLOSET TOILE A'R COND.UNITS—N.P.EA. <br /> BATHTUB REFRIGEFATION UNITS—H.P.EA _ <br /> UVnTORY1WA5H BASINI BOILERS—M.P.EA. <br /> SHOWER GAS FIRED AC.UNITS—TONNACE EA <br /> KITCMEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> OISIIWASHER WALL MEATEflS—B.T.U. M <br /> LAUNDRYiRAV UNITHEATERS—Bi.U. M _ <br /> CLOiHES WASMER EVAPOf7ATIVE COOLERS _ _ <br /> WATER HEAiER CLOTHES ORYEPS _ <br /> UAINAL VENTILATION fAN _ � <br /> ORINKING FOUNTAIN RANG[HOOD <br /> FLOOR DRAiN AIR H�NOLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> FOOF DPnINS—AA�NLEADERS METAI F�REPLACE 8 CHIMNEV <br /> SIKK�SERVICE—BAR,ETC. _ WOODSTOVE/FIREPLACE INSERT <br /> SUB T0T11L S � <br /> SUBTOTAL <br /> PEPMIT 3 PERMIT S <br /> TOTALFEE f TOTALFEE S <br /> THIS PORTION TU BE COMPLETED BY BUILDING DEPT. PERSOfvNEL <br /> INIEE�O�CN NEA8SEl0ACK SIpE5E19�CK �UNGHEGNNUMO[R <br /> � PLANC��EGnfEE <br /> iEE FECEIPf NO <br /> '20NE LOtARE� y�CANTSiIE FEES V�LU�TION FEE _ <br /> pYES ONO <br /> fOFCONSf OLGUPeNCYGnOUP NOAFOWELLINGUNIIS _ <br /> BUILUING s <br /> E O�BLDO NO.OF SIOIUES MAX OLC.IOA� <br /> PLUMBINO <br /> MECHANICAL "� � <br /> �E SPRINKLERS REOUIFED ❑ YES ❑ NO <br /> Oi1/Eli <br /> PENAITY <br /> ll„AiIOHALC 9Y PUNSCHELNEDOY APPR FJRISSU�NGEBY " ` <br /> � TOT�L _ !� <br /> � <br />