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In�EvsrO�sen '��:.PPLICATION FO�.� �Yffe„ <br /> °�TM°F CONSTRUCTION <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259�8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑COMBINATION Ti�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> �N'ri��� Mni��onn[ss cm zia <br /> PNONE <br /> � �,J, ..• <br /> L :i � .t i:i(�-:4 ��r i �<. �I YG.-t,.���ciC� F�"J' � _ /.S JL'� � � ' .S J Y J <br /> �1 C UIEGI OR pCSiGHEq MAIL�DDRCSS CIfY ZIP PNOH[ � <br /> r.u�cnei corrtnncron M�IL AUOI1E55 CIfY ZIP PIIONE LILENSE• <br /> � <br /> l ...-t. .._ C�.,.Ji: '��t>7ix��C.' l�c.ir� Ct�:�ccY'1 %�.i 't � � �,�'-�.�5; f.S'_7- jj,• � <br /> MI�.C1411iUL CON�RAC�OO M�IL�DDRE55 CIiY 210 PNOH[ LI[ENS[• <br /> PLUIIBIN.CON�MC1011 M�ILApORES$ CIIY ZIp <br /> PIIONE LICErILC� <br /> CUSSOf WONM <br /> ❑ NEW � AODITION ❑ ALIERA710N ❑ RE?AIR ❑ DEMOLITION ❑ WOO�STOVE/FqPL.INSERT ❑ BUILDING RELOCATION <br /> wiy�uonnr wona�cos�or unttnuis rwst�oom <br /> 1 i <br /> � Al . t� �i <br /> n[scmui�wonK <br /> � , . < , > ,,.., � � , , ,, � . r....,,- ���_��,� �,.... � �;,�,� „ . � ., .., � -,�;r. .�,.�, <br /> U5f Of OOILOINO <br /> - I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> "'" ' l"-"'^ ` PLICATONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> imaiocscnumoHorrnorennisr�owr+a[wwor,nnecNrounconiesi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISiVPE <br /> io��%'� owcr`��_�or �'" '�"��� ��-'�' � '�i�����-� OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL iHE PROVISIONS OF <br /> ANYOIHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNAIUfiEOFGONIARCTORORAUIMORI2EDAGLNI DAtE <br /> " k -_ =�, � c:/� z/a�.c <br /> 1'IiOJlCi AppNE55 pPPLILANiS C11Y 6USINESS lIC[NSE NO <br /> �`�7. �5e � l � e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIKTURE FEE NO. TYPE OF EOUIPMENT vEE <br /> WA7ER CLOSET�TOILEn AIR COND.UNITS-N P.EA. <br /> BATN7UB qEFRIGERAiION UNITS-N.P.EA. <br /> LAVATORV I WASII DASINI OOILE(75-H.P.G. - -- <br /> SHOWHR GAS FIRED 0.C.UNITS-TONNAGE EA <br /> NItC11EN51NK8DISP FpRCE0AIR5Y51EM5-O.T.U. MEA. <br /> _ �ISNWnSNER WALINEATE175-B.T.U. M <br /> LAUNDNYiRAV UNIiHEATERS-B.T.U. M <br /> CLOIHES WASIIER LVAPORATIVE COOLERS <br /> WAiER HEAIER CLOiHESDRVERS <br /> _ 11RINAL VENTILATION FAN <br /> DHINKING fOUNTAIN RpNGE I100D <br /> �IOORORAIW A;RHANDLINGUNIf- C.F.M. � <br /> V�CUUM 6pEANERS STOVE <br /> ROOF DRAINS-fi�INLEADERS MET�L fIR@PLACE 8 CHIMNEV <br /> _ SINK�SERVICE-BAR,ETG WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUBTOTRL S <br /> _ PERMIT S PERMIT S <br /> __ TOTAL FEE 3 TOTALFEE i <br /> THIS PORTION TO BE COMPLETED BY BUILDING DFpT. PERSONNEL <br /> ��WI15[�OACn pGRF210ACN SIpE5Ei8�CK PLRNCII[CNNUNBLR V`ANGB[LN![E <br /> � ��� � fE[ /�y�� ��EIPiN; C, <br /> �:E20NE 101Ap[A � /. � /��•� , <br /> VACANISiIE FEES VALUATION fEE <br /> ❑YES O!10 <br /> �i�[OfCONSi. OCCUPANGYOIi00P NO.OFOW[LlIN6UNli9 <br /> BUI�OINO f <br /> VC Of O100 NO O�SIUI11C5 MAK OC4 LO�O <br /> PlUMBiNC <br /> MECHANICA� <br /> iRE SPPINHIERS i7E0UIf7tD ❑VES ❑ NO <br /> OTMER <br /> PEIJAL7Y <br /> �'�IiC41�pN�CC Ov PLn��SCULCREDOY APPR.fOf115SU�NCEBY - - <br /> TOTAL <br /> �� �� <br /> � <br />