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` �,E,�,� �;PPLICA":ION FO� ����„ <br /> � p^� CONSTRUCTION <br /> � everett PERMIT e <br /> DUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMB�NATION �BUILDING ❑ MECHANICAL ❑ PLUMBINO ❑SION <br /> py� p M�R�ODRE55 LIfV ZIP PIIONE <br /> ��t/n�t �- f��X' � U�U �ag�l'�a`- SuJ. �7.PrP� l.uF� 9�� •�7-�/Q3 �� <br /> ♦f1CMITELiORpEKiONER MqL�DONE55 CITY ZIP PIIONE <br /> Ait"/��� ���r�� � � 5�ixt f�t Q r�� (.cirv�ll.Y�t`�t 14 98Ck�3 77g•G5�0 <br /> OENEIUICONiR�CtON M/d �DORE53 GIIV Z�P opONE LICENOE• <br /> ���d1��.�%��ih �t-sr.r� ��eie.�l !�R Q�xa� .�7-��� �����,v�iR <br /> MEGM�N�C� CONTR�CTOq MAII�pORE59 GIIV ZiP PHONE 4CEN9E• <br /> � <br /> KUMlINOCONiR�G1UR MM111�011E59 GIfV 21P PIIONE LICENSE• <br /> CUb9 Oi WORK <br /> .� � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDINQ RELOCATION <br /> AlU�T10N Of WORK ICO51 Of M�IERI�LS PW S LABORI <br /> ��1 fl`'C� c:t' <br /> DESCRi! Rn <br /> D /I�C � C �U ' <br /> ' uae w su�� I HEREBY CERTIFV THAT I HAVE READ AND ExAMINED THIS AR <br /> � �� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEO�LOESCRIPf10NOiPROPERfY�9NOWNBELOWON�TT�LMFOURCOPIE51 ppOVISIONSOFLAWSAN00RDINANCES�OVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHEiHER SPECIFIED HERE- <br /> �oT_e�oc�or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br /> ANY OTHEF STATE OR LOCAL LAW REGULATINO CONSTRUCTION <br /> i — OR THE PERFORMANCE OF CONSTRUCTION. - <br /> SIGNATURE CONiR�CTORORAUTHORIZE0�0ENT UATE <br /> ' ,� X G�_ a�/6 <br /> MIOJECT�DDRE85 �PGIIC� iSCIT SSUCENSENO. <br /> ; � �e � �e� wg _ , <br /> i K{IM�INO MECNANICAL <br /> i NO. 7YP[OF FIXTUIIE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND.UNITS—H.P.EA. <br /> I B�TMTUB REFRIGEF�TION UNITS—H.P.EA <br /> � UVATORV WASH B�SIN BOILERS—M.P.EA. <br /> f <br /> F SHOWEP OAS FIRED AC.UNITS—TONNAOE EA <br /> ( KITCHEN SINN 6 DISP. FORCED AIR SYSiEMS—B.T.U. M EA. <br /> DISHWASHER WALL H[ATERS—B.T.U. M <br /> � LAUNDRVTRAV UNITMEATERS—B.i.U. M <br /> CLOTHE9 WASHER EVAPORATIVE COOLERS <br /> WATER MEATER CLOiHES ORVERS <br /> URINAL �EN7ILATION FAN <br /> ORINKINO FOUNTAIN AANOE HOOD <br /> FLOOR DRAIN AIq HANDLINO UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF OMINS—RMNLEADEHS METAL FIREPLACE 8 CNIM�EV <br /> SINK SERVICE—B�F E7C. WOODSTOVE/FIREPLACE INSERT <br /> � SUS TOTAL SUBTOTAL t <br /> PERMIT t PENMIT f <br /> TOTALFF� t TOTALFEE ! <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONiSETB6N REARSEIB��K Si0E5ETB�GN PL�NCHEG NUMBER )PUNCNECKFEE <br /> � A, NJ/�� N�_ �](�f �'1 / fEE l=`" AECEiPTNO /�'/^� <br /> � UlEZONE IOi�PE� O ( I ��r�� 'rJ� 1L1� � /�j;_J <br /> 1 WC�NT SiIE FEE9 V�LUIITION FE[ <br /> C_ '(/ P� //� OYES �NO <br /> T <br /> T'VEOF�NST. OCCU��NCYGNOUP HOAFOWElLINOUNIiS <br /> �- r �2 ,$Z � a���o�N� _ ��oeo � oz� <br /> 64E OF BIDO NO.OF StORIES M�M.OGf. :OAD <br /> ���'tJ"U � 2 N�� • P�UMBING <br /> MECHANICAL <br /> ' FIfiE SPRINKLERS REOUIFED O YES NO <br /> OTHEF <br /> PENPLTY <br /> I1VPlICAiION�CGBv PUNSCIIEGI(EDBY ��PR.FORISSUANLEBY <br /> �',. G . G To.�� <br /> �� iy.� <br /> �.c�{ (3..{3k z� tite�M- curc.c. <br /> � . <br /> ��3�.u.�-E ��9zE+T� ('B�+'t?5 .. <br /> .,. ,... .... ..... ... .:. .. . ... . _ . . . _ <br /> . . _ .�...._.... <br /> ..... ..... ... , �. _ . . . <br />