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� S'�PPLICATION FOf::> <br /> , <br /> � G Eo+fpn�n everltl <br /> � everett CONPERM TTION <br /> e � <br /> BUILDING DEPARTMENT <br /> , 259•s745 TQ BE COMPLETED IN INK- PLEASE PRINT <br /> I <br /> ' ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> 1 pWNER MMl�UDf1[55 GIfV )P PMONE <br /> ; GFp� �_ '��.r,�ez �?�� �Ayd���� ���� �,�Ju �d3 3y7 �� <br /> � A'1GMITECTOPOE&ONEN MML�DURE39 Clrv ZIP PHON[ <br /> 1 <br /> I <br /> � OENEMIGONTR�CTOP MMl�00BE53 Q CrtV 21P PHONE ' LICENSE• <br /> i �- C=_ (�-IC���a�. S�73S /�ul�u�/vU• �`'u/- ll,� 98��3 3�7 d�<0 <br /> �' MECHANIC�LCONiR�CTOq MNl�00RE99 dfY (/^2�,1P pMONE LICEN6E• <br /> � ' V � IV/,�. K� /y.8/�� <br /> 7 PIUMBINOCONTR�GTpq MAIL�DO�E59 CIfY ZIP PIIONE � �ICENSE• <br /> j ' <br /> 3 C,.L.A,/890F WOHK <br /> � l7 NEW ❑ ADDITION ❑ ALTERATION ❑ (7EPAIR ❑ DEMOLITION I_7_WJODSTOVE/FRPL.INSERT ❑ BUILDINO RELOCATION <br /> VAL W TION OF WONN�COST Of M�IERI�IS PlU9l�80R� <br /> �1 OElCPilE WORN N^� . � <br /> 7 W '✓n� ' <br /> � useoreuay`w,Q' I HEREBY CERTIFY THAT I HAVE HEAD ANO ExAMINED THIS AP- <br /> � 1C.Fis� t�iZ+JT PLICATIONANDKNOWTHESAMETOBETRUEANUCORRECT.AIL <br /> � <br /> ` LEU�LDESGRiP110NOFPPOPEPfY�SHOWNBELOW011ATT�CNFOUHGOPiES� PRC\'ISIONSOFLAWSANDORDINANCES60VERNINOTHISTYP_ <br /> r OF WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HER�_- <br /> j �ot�I�eix�_or IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> � ^ .- GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OK <br /> U ANYOTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br /> j / OR THE PERFORMANCE OF CONSTRUCTION. <br /> � _ � V ULwI�L � SIGN�TUREOFCONTR�CTORORRUTHORIZEDAOENT DATE <br /> o� 5 � X " -�..�. _ �- �s-� <br /> � PMOJECT�OURE85 - PU iSCrtYBUSINE95LIGENSE':O. <br /> ; 3� r <br /> � KUMBINO MECHANICAL <br /> N0. TYPE OF Ft%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER GLOSET TOILE � AIR WNU.UNITS—H.P.EA <br /> � BATMTUB _� qEFRIGERATION UNITS—M.P.E�l <br /> LAVATONY WASN B�SIN UOILER^a—H.P.EA. <br /> 9HOWER GAS FIRED AC.UNITS—TONNA6E EA � <br /> NITCMEN S�NK 8 DI9P. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> ' DI9HWASMER WAIL HEATERS—B.T.U. M <br /> ''' � UUNDRYTF�V UNITHEATERS—B1.U. M <br /> �`' CLOTMES WA9MER EVAP�IRATIVE COOLEPS <br /> CLOTHES�RYENS <br /> ' ' URINAI VENTIIATION FAN <br /> � � DRINKINO FOUNT�IN RAN�E HOOD <br /> ' FLOOR DNAIN AIR HANDLING UNIT— C F.M. <br /> ' - VACUUM BFE�HERS STOVE <br /> ROOF OMINS—RAINLEADERS METAL FIR'oLACE 8 C4IMNEV <br /> SINK SERVICE—BAri ETC. N'OODSiOVE/FIREPLACE INiERT <br /> Y <br /> a <br /> � <br /> � SUBTOTAL SUBTOTAL f Z O <br /> PERMIT S PERMIT t <br /> TOTALFEE 3 TOTALFEE f <br /> � THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> I FpONT5Ei8AGlt 4E�RSETB�CM SIOESEi9�CR PUNLNEGKNUTABEH PLANCHEGrcFEE <br /> 20 � 2� 7 Z � U p I� dl`� fEE �{/� �5 PECEIPTNO QG'1�� <br /> ,� _-- u -� �r �.�al <br /> UBE20NE v LOT/.RE� y CANTSIfE <br /> 1 P_ ` �� j YES �NO FEEB V�WIITION FEE 3 G <br /> �� � <br /> � TYPEOFCONST. OCCU°�hCYGROUP NO.OFDWELLINOUNIT9 <br /> i � � ��� / BUILDINO f <br /> j <br /> I B:IE OF BLDO. NO.OF 9TORIE9 M�K OCG,�/IOAAp <br /> � . .. SzI �F /�' /.�,ssT ry�rj PLUAIBINO D <br /> MECM�NIC�L <br /> � FIRF SPRINKLERS REOUIREO ❑'fE5� NO � . <br /> j OTHE <br /> � � � PENALTV <br /> APFLIWiION�CC BY PIAN9CNECNEDBY �PPR.FOBISSIUNGEOY <br /> � ,� ' /� A TOTAL <br /> ! � /� <br /> �- .�.��..r.�. �... . ....�.��.-_..�--�^- ..... . .......at-� .r�� . .. . �. . ' ' il I ' ' �iT'_. <br /> . .� 4 . . .�. ; . ..:. <br /> � . �.. �.�.. <br /> ♦ . .� , b :. '_... <br /> ��.:'.h •... • n'. �. . . � ,:� ... � • . .. <br /> , . <br />