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APPLICat10NP O�R�CIONSTRV.:TION <br /> ,.,,.,,.�� <br /> ;^�c Ccergrren � <br /> QTY CF <br /> everett <br /> BUILDiNG DEPARTMEN7 TQ gE COMPLETED IN INK— PLEASE PRINT <br /> 259�8810 , ,,;•,i <br /> cnv ziv <br /> MiIL AOC�fSS <br /> �,���� � . ��; g s Zo s 34 5_s"S o5— <br /> S 3715 �U�AAN� UC��� 21P PNONE <br /> ��A• anI � (IjUMF'� OD [SS ���` <br /> V n� <br /> LENANi <br /> C'Y Z�p VNONE <br /> MML�D�PE55 <br /> �pCXrtEQ OA OESIGNER — <br /> GITY <br /> 21P FNONE L6ENSr• <br /> GENEPALCONTRALiOR <br /> MAIL AODAE55 <br /> CIiY ZIF <br /> PNONE IIGENS[• <br /> M.��.00�Ess �{ 3��.�5 NdR�HC-y13'�H7 <br /> �C� idECH�NIPLCONiP�LiOA ,�1 ,)Ai4 -[ }I�LC� pHONE LiCENSE• <br /> py ��Uc,.�_•�C,,.n�.r• �I �F �,e:17 I't,;.u.w ci�r ziv <br /> A � � VlpM01NGCONiPALiOfl ! MM1�00�E55 _ _ <br /> .�yy y l;LP550FWOPN <br /> N�'.;. � ryEy� ❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERi ❑ BUILOINGRELOCATION ____ <br /> �� � — LONLnLioEFSDN/.NDGMONCNO . <br /> I�N2Li IMPF W EMENL OR INtEP10P REMODEL ONLY _ <br /> H � — –�__ <br /> �� � CO41PACiPFICEOi WORK ------- — <br /> OlSCPIBE WORN AND SOVARE�OOIAGE INVOWEO <br /> N HHH � � �n _- - — <br /> � O � �!�� INEREBVCERTIFYTMATIHAVEREAOANOE%AMINEDTNISAPPLICATIONAND <br /> n:c�•o5Eou5EOv wi KNOW'.MESAMETOBETRUEANDCORREGT.ALLPROVISIONSOFLAWSArvD <br /> y b - ORDINFNC[5 GOVLRNING THIS T'FE OF WORK WILL BE COMPL[TED\'.'ITN <br /> O H ��aiU[SCPiauorvOFPPOVEatt�SHownBELowoaAti�CHfoURGOMESi y�HETHERSPEGFlEDHE�EINORNOT.THEGRANiINGOFAPERMITDO[SNOT <br /> �n �y PRESUtdE TO GIVE PUTHORIiY TO�IOLATE OR CANCEL�HE Pl�OVISIONS O� <br /> H Ci1 O ANYOTH[FSIAIEORLOCALLAWREGULATINGCONST�UC110NORTH[PE�3� <br /> H� O �pr OIOCx OF Fpp�J,pNCE OF LONSTRUCTIO v iHAT I AM AUTMOFIZ[D�Y THL OWFEP OF <br /> xH � _ THISPFOPERTYTOP[FFORMTHEWORKPORCd�iICHl�PP�IC��ilON15tdPDE <br /> � � AND I COMPLV WITH 111E SiATE GONTRACTORS V�YJ �t=5i PCVJ �ND <br /> x 29f 200 W-4C <br /> H H „cr:r.w�corcn�nuenr.rn�.�m,.on¢macou osi� <br /> N �/ p <br /> C] C7[A ' _ A � l4 l�(��1.. <br /> �� r _ —-- -i�v+-�� 9.�'1�,�-� _d�-_-- , - <br /> �lvruc:�ns n���.�s,•�osucrvse•�onrvoousuEssrie+.� <br /> [�1 �np�ea.wi�ess <br /> H o v'n :=i � � 1 1l/ <br /> MECHFNICAL <br /> � PLUM9ING TypEOFEOUIPMENT - FEE <br /> FEE Nn• <br /> NO. TVPEOFFIXTUPEORITEM q�C-q�HNDLGUNRS-NP__ _ _--- --- <br /> WATER CLOSET ITOILEA FORCE�AIR SVSTEMS-O1U. _h1 EA __ _- --- <br /> � BATHTUB UNITNEATERS-_BTL. �+� — -- <br /> i _ LAVATORVI�VASHBASIN� CLOTHESORVE�S -- <br /> ' �t SNOWER .. <br /> _ - VENTILATION FAN -- <br /> � KITCHEN SINK 8 DISP. RANGE HOOD <br /> DISHWASNER WATEFHEATER � — <br /> -- �AUNORVTRAV 1vOODSTOVE -- -- <br /> i 1�� CLOTHES WASHER _ METAL FIREPLACE 8 CHIMNEV _- -� <br /> ; ���� URINAL �� FIREPLACEINSERT ----' <br /> , DRINKING FOUNTAIN HEAT PUMP --' <br /> FLOORDFAIN 1 GASPIPING -- � <br /> � BACKfLOW PREVENTERS -� t- - <br /> E%HqU/�r� � �'_ , <br /> �1� ROOFORAINS-F1A�NLEADERS _ — � � <br /> SINK�SERVIGE-BAR.ETC 1 � -- <br /> �1 -- —_ _ _._- <br /> - - SUOTOTAL 5 __ � .� <br /> SUBiOTAL 5 — PERMIT 5 � <br /> I_t,_1 PERMIT g -- TOTAL FEE 5 � <br /> TOTALFEc 5 iEE neccirrr+o. <br /> � REAR 5[iBRCB SIDE SETBPG1t VIAN CNECG HUMBEfl <br /> FRONfSEiBAGN <br /> - - VALUATION FEE <br /> vnC��+T si*E FEES <br /> USE20HC LOtAREA p VES �� NO <br /> BUILDING _ __.— ------ --- <br /> ttPEOLCONST. OCCIIW.NCYGRDUP NOOFOWELUNGUN115 ---� <br /> FLLOW�BLEIAGiUnL PLUMBING — — —_ —, _���� <br /> � <br /> vzeoretoa. NOOFsoai[s nY*� °Cc1O"o MECNANICAI - <br /> �H <br /> ��ewHruMire*iorv OTHER ---- -'- <br /> STATE DU�LDING SUFCHARGE ___- — - - <br /> i IPE SPPIHKLERSPEOUIREU �YES �NO _ <br /> 51ATEEN[FGYSURLMARGE __ ___ -. — -- -- <br /> pp{'UGRION ALC 0V PLPNSPPFR BV p�(7l.IC WORNS � <br /> TOTAL <br />