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APPLIC��ION FOR C01�1STRdCTION <br /> PERMIT <br /> fhe Erorpreen <br /> qTY OF everel� <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-ee�o TO BE COMPLETED IN INK—PLEASE PRINT <br /> OWNEP � M�R/.DORE55 GiIY Zu' VIIONE ' <br /> ��<4=�a,r�;�m�. �;�.� Mi{k��fe� �,.,___�.�sk,�Ll-� G.� j<;� -20�� <br /> TENANT M�iLADDRE53 p1V Zi� \ " PNONE <br /> �t,�lrx T'c� 2`�-�� �e.r �Ave �E,�Q�r�f-1- ?�s7�-��,��� <br /> MITEC RDES�ONEN M�iUDOPE55 piv ZIP PNONE <br /> O`EN^EfULCONTP�CTOR M�II�DUPE55 1p/rv _ PHONE UGENtE• <br /> MELNAHI, LCONt��Y`'� V I��S � l_l SG1. �"� �/(�' .W� -IQ�'� J�3,0'��1 ENSE• S <br /> PLUM&NOGONTPACTOR Mn�L�UDRE59 Cllv Zi� PIIONC UGENSE• <br /> CLA490FNVPR .� � <br /> ❑ NEW ❑ ADOITION ❑ ALiERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJFRPLINSERT ❑ BUILDINGPELOCATION �,)�� � <br /> TEN�NT IMPHOVEMENT OR INiE1ZlO�fl RE/M�O/�DEL ONLY GONi�GI PE�SON�NO PIIONE NO ' <br /> ^fANTR�CTPi110EOFWORK �� O-�lJ� <br /> OE9CRIBE"�'K�NDSOl1AREfO0i�0EINVOLVE� <br /> � .'�jT S�F (,�1�,� IMa.u1� <br /> PFOV09E0 USE OF BUILDIHO cw I HEREBY CERTIFY THAT I IiAVE READ ANU EXAMINED THIS APPLICATION AND <br /> � II'�!i C�' �iC-UICPJ _ KNOWLHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br /> LEd1L0E5CRIGTIONOfPHOPERttISNOWN6ELOWORATI�GMFOORCOPIES� ORDINANCESGOVEFNINGTHISTYPEOFWORKWILLBECOMPLFTEDWITH <br /> W HETHER SPECIFIED H EREIN OR NOT.THE GRANTING OFA PC-RMITDOES NOT <br /> PRESUME TO GIVE AUiHOR1TV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Lot e�ocK oF ANVO7HEHSTA7EOPLOCALLAWREGULATINGCONSTRUCTIONOR7HEPER� <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> THIS PROPERTV TO PERFORM 7HE WORK FOR WHICH APPLICA710N IS MADE <br /> - AND 1 COMPLV WITH THE STATE CON7RACTORS LAW 1827 FCW AND <br /> 29620 <br /> SiGNA REOf .ONiMC10 Ull10PIZEDeGEN1 "NE <br /> X � ,�q <br /> P{10 �RE � pppL N•SG Ej$� NO S�AMEN • <br /> J <br /> UMBIN MECHANICAL <br /> NO. TYPE OF FIIITURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn A/C—A/HNOLO LMITS—H.P. <br /> BATHTU9 FORCEDAIRSYSiEMS—BT.U. MEA <br /> LAVATORY(WASHBASIN) UNITHEATERS—B.T.U. M <br /> SMOWER CLOTHES DtiYERS <br /> KITCHEN SINK 8 DISP. VENTILATION FAN <br /> DISMWASHER RANGE 1100� <br /> LAUNDRV TRAY WA7ER NEATER <br /> CLOTHES WASHER WOOD S70VE <br /> URINAL METAL FIREPLACES CHIMNEY <br /> ORINKINO FOUNTAIN FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAI�;LEADERS EY.HAUST fAN <br /> SINK(SERVICE—BAR,ETC� <br /> 3UBTOTAL S SUBTOTAL 5 <br /> ' PERMIT S PERMIT S <br /> TOTAL FEE S WTAL FEE S <br /> FROHi5E18ACN RGRSEIB�CK SIDESEI6RCN PIAHCNECRNIIMBER FEE PECE�WNO. <br /> usEzoNe wtene� vncnNtsne FEES VALUATION FEE <br /> C�L OYES ❑NO <br /> BUILOING <br /> TY{'EOFCOV91. OCCUPANCVOROUP NOAFp\YElLINOUNlT9 <br /> �LIOWABLiJ�CTUAL <br /> PLUMBING <br /> srze or e�oa no.or sromes osur. occ w�o <br /> U Y MECHANICAL <br /> O N -- <br /> MEIGIItLIMiiAi�ON OTHER <br /> � PNESPRINK�ERSREOUIRED ❑YES ❑ Ho STATE BUILDING SURCHARGE <br /> STATE ENEFGY SURCHARGE <br /> APFLIL�TION�GC BY PL�NS�PPP.BY <br /> n'I PUBLIC WORKS <br /> `"lU 1 <br /> tl U+ TOTAL <br /> _..-A - -..., .. . . . .:. . .. .._. . . . .. .. . <br />