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`^E°�� �i� CONSTRUCTION� `""°" <br /> everett PERMIT O <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ NUILDING ❑ MECHANICAL ❑ PLUMBING ❑SIGN <br /> OWNEN M�Il�O0RE56 CiTY Zin 1'NDHE <br /> C�9F Ef/E2E7T"' !`tTY l-GKC �G02 61�6TKAR6� E1�2ETT '/��'20I '� SY � 7 Y I <br /> MCMIIECTOpOElOHEP M L�OOPES9 CIIY ZIP vNONE <br /> O�EN+ERI1lLOHfq�1�q MMLADOPE55 LIiV 21P PHONE LiCENSE• <br /> L—E.vr�2 �-Jc,z-��/� _T.vc �I r'7 s.�.J. � (9 t� C`�a rr E 9�i�¢ b �'�S,SJ'.(� ('s�v-�p z cvar <br /> MEGN�N C�L CONiMCTOq M L AOOHESS Clrv 21P PMONE LICENSE• <br /> %UMBINOCONTMCfOR MMLAC�RES$ CIIY IIP PIIONE UCENSE• <br /> C1A560F Wq11c <br /> ❑ NEW ❑ AODITION ❑ ALTERATION ❑ REPAIR � DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCRTION <br /> wwenon os wonK icoar ov weremas vws�eeom <br /> 2 00 0 <br /> DE���/ ]E WOPK <br /> .L/�/k'�L f S!J �/�-Q ��-�!O� <br /> JBE OF�l1iLOtNO <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> LEY�LDEHCRIpTIONOFPqOPEPfY�9NOWNBELOWOR�IT�CHFOURCOPlE9� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> PROVISION30F LAW3qN0ORDINANCESGOVERNING THISTVPE <br /> �ot�e�oc�or OF WOHK WILL BE COMPLETED WITH WHETHER SPECIFIC•D HERE• <br /> IN OR NOT.THE GRANTING OFA PERMIT DOES NOTPRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCE�. THE PROVISIONS OK <br /> AN Y OTHER STA1E OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. ' <br /> SION�TUREOFCONiqACTOR AUTMORI2EUAGENT DATE <br /> X � •� � //-4- �6 <br /> PIqJECT�ODRE33 � �FPUC�NBCITVBUSiNE55LtCEN5EN0. <br /> � � �3 f� �6r� /�6 9 <br /> � PLUMlINO MECHANICAL <br /> N�• TYPE OF FI%TUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> i _ WATERCLOSET TOILET) AIRCOND.UNITS—HP EA <br /> BATHiUB REFHIGERATION UNITS—H.P.EA. <br /> LAVATORV WASH BASIN� BOILERS—H.P.ER. <br /> SHOWER GAS FIRED AC.UNITS—TONNAGE EA <br /> KITCMEN 81NK 6 D13P. FORCED AIR SYSTEMS-8 T U. M ER. <br /> DISMWASHER WALLHEATERS—B.T.U. M <br /> IAUNDRYTR�Y UNITHEATCRS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHESDRYERS <br /> URINAL VENTIIATION FAN <br /> DRINKIN6 FOUNThIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLINO UNIT— C.F.M. <br /> V�CUUM BREAKERS STOVE <br /> HOOF DRAINS—PAtNLEADERS METAI FIREPI.ACE 8 CHIMNEY <br /> SINK SERVICE—BAH,ETC. WOOOSTOVE/FIREPLACE INSERT <br /> 9UBTOTAL SUBTOTAL = <br /> VEHMIT = <br /> , TOT�L FEE PEPMIT { <br /> � TOTALFEE _ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �ONTSEiB�CN ` • <br /> FE�PSEIB�CK S�OESEiB�GR PLANGNECKNUMBFR PL�NGNECKFEE ' <br /> fEE RECEIPiNO. � <br /> +FZONE IOi�PE� <br /> VAC�Ni51TE fEE3 V11LUAilOH FEE <br /> OrES pN0 <br /> PEOFCONSt. OCCUF�NGYGROUP NO.OFOWELIINaUNlT3 <br /> 'EOfBLD6 NO.OiS10f1iE4 M�X.00C.LOA� BUILDING s . <br /> PLUMOING <br /> MECHANICAL ' <br /> 7E SPqINKLERS REOUIREO U VES ❑ NO <br /> OTHER <br /> 'LIC�IION�CG.BY O��NSCMEGNEDBY APPq �OR155U�NLEBY PENR�TV <br /> TOTAL <br />