Laserfiche WebLink
��sE•rryrNn 'xPPLICATION F0�1 ���,�„ <br /> ��TM�F COiVSTRUCTION O <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASi PRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PWM6ING �SIGN <br /> OWNEN MRILPOORE55 GIIY 21V PIIONE <br /> JEFF �ot�i-�flCi-1 ��1/2 /:ULiCEi25r tUE2�t't' [J/1 Ct'8ZU I o?SS' ��� <br /> ARLMIfELTOR0E51GNER MAILPDORE55 GIiV ZIP PHONE <br /> OENENALCONIRACiOR �1�IL�OORE55 CIIY ZIP P110NE E 'SE <br /> e,�r.A:��'6�K Ct.:,v) <br /> C�TS� .S/Gn/S'c�UiCc �:J:.�X ZZ/ 7 fr/f_`2�TT l��1' 9b"Zo3 339-26�/� C�rY�II)y UeC�E�rc; <br /> MECN�NI�ALCOMR�CIOF MAIL�ODOSSS LIiY iIP PNONE 4CENSE• <br /> pWMBiNOCONiPACtOR M�IL�DORE55 CIiV 21P PNONE LICENSE• <br /> CL�55 O�WOPR <br /> � NEW C� ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA710N_ <br /> V�W 'ONOFWORN�L09TOFM�}EPUlSPW9L�BOfry <br /> �{(o.DU _ <br /> DESCRIBE WORN <br /> /N57A{L /Q Da�dcE FACE ,�:� ihaJ.�i? d��Y'CLUMiy.a1�/� SGn/ o,v roP o% ��SrrUr, S�G�I <br /> useorouaou+a I HEREBY CERT!FV THAT 1 HAVE READ AND EXAMINED THIS AP• <br /> �,4/,JT ,�TOn� PLICATIONANOKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> «ceioescnirrior+orrnorenrv�sNowHee�o�+onenec��rounc,vies PHOVISIONSUFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> �COTS ol/�2.2Z3 �:�/ .73- z(� OFWORKWIlLBECOMPIETEDWITHWHETHERSPECIFIEDHERE• <br /> eor�cvc�.—or IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> �IVE AUTHORITY TO VIOLATE OR CANCEI.THE PROVISIONS OF <br /> C�OL.I� Io70 U'' R/7�TQF �(IEkET7 5410 C'O •4 ANYOTHERSTATEORLOCALIAWFEGULATINGCONSTRUCTION <br /> OR TfiE PERFORMANCE OF CONSTRUCTION. <br /> CQMMO,�J q�0/zC,fs ��p0`/ � �O�Z M1UC�ErQ�yL� SIGNRTUR ��ONTRACTOPORAUTNORIZE�AGENT D4TE <br /> X �" uJ Dz�--�� lv-S�lP <br /> VROJELT ADORESS �PPLICPN P�CiTY BUSMESS I�CENSE NO. <br /> o?8/z 2�C�EQ U� VE,eE�/ r.ya 98zo / /G�/ola <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENi FEE <br /> WATER CLOSET�TOILC-n AIR COND.UNITS—H.P.EA. _ <br /> BATHTU6 REFf71GERATION UNITS—H.P.EA. <br /> LAVATORV WASH BASIN) BOIlERS—N.P.EA. <br /> SHOWEfl GAS FIRED AC.UNITS—TONNAGE EA <br /> KITCMEN SINK 8 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WAIL HEATEflS—B.T.U. M <br /> LAUNORYTRAY UNIiHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATEH CLOTMES DRVERS <br /> UPINAI VENTILATION FAN <br /> DRINKING FOUNTAIN RANCaE IIOOD <br /> FLOOR ORAIN AI(7 HANDLING UNIT— C,F.M. <br /> VALUUM BREAK[RS STOVE <br /> FOOF ORAINS—RAINLEAOERS METAL FIREPLACE 8 LHIMNEY <br /> SINK SERVICE—DAR,ETC. �':OODSTOVE/FIPEPLACE INSERT <br /> SUBTOTAL SUB TOTAL S <br /> PERMIT f PERMIT s <br /> TOTALFEE 3 TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNCL <br /> FRUNI SETB�CN PEPR SEIB�CN SIOE SETBRCH PLRN GNEGN NUMOER PLRN CHECN FEE <br /> FEE RECEI�I NO. <br /> USEZONE lO1�RG ypCRNT511E <br /> FEES VALV�TION FEE <br /> ❑YES ONO <br /> TYPEOFCONSi. OCLUPNNLYGROOP NO.OFOWEILINGUN1i5 <br /> BUILDING S <br /> SRE OF Bt00. NO.OF SiOR�ES MRX OCC.lOr10 <br /> PlUM01NG <br /> MECHANICAL <br /> FIF7E SPRINKLEPS fiEQUIRED ']VES ❑ NO <br /> OTHER <br /> PENALTY <br /> RPPLIC�TION�CG.BY FL�NS CMECNED BY APP0.FOR I55 C � Y <br /> TOTAL <br /> /� .vli]yct.v�uM �e1E3zs2'B.v OvF�P. I�cU <br /> . B-� <f� f-T <br /> � G���7 G�-iE G[.GY�� �7�A� <br /> (�•io•8� `� r"T Tv f�c�� o� c.u�¢E3. <br />