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IMErwpNn A�:pLICATION FOR J <br />°�^°� CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PHINT <br />ereretl <br />e <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW11 MqI�DDRE55 CIiV IIP pNONE <br />�1��ri�d I �5 f�-e- ,+,_•� �-s i,2,?h ��o s s�.'n, C—c�erF•`/f `l'3'�-' v 3 3,�3 = 5� s`'f <br />C t[Ct0 PESONE qL�ODPE54 GiiY ZiP PNONC •♦ <br />7'. . ... <br />ClNEHµ[UNiP1C10R M�ILAOUNE55 CITY ZiP p110NE LICCNSE• <br />MI.f.�1�NiU� CONIO�CfOq M�IL �OOPES$ CIIV LiP PUONE tIGENSC • <br />PWMBiH�CONIRApipq MMLADDRE55 CITY ZIP PIIONE LICENSE• <br />CUSS Of WOPK <br />❑ NEW ❑ ADDITION � ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VM11�liONO�WORNIC05101"M�ICIIIµ5VLO5L�90R1 � <br />-�' l,�ta • — <br />uAf Of A1LlDiNG �' <br />17��•r..9t�e:�a '^��� /.� f /�7f�� <br />ILML ESCBIP�IO O[PpOPERf �SMOWNBEIOWORR I�CNf <br />�o�—aioc�ov <br />h: n <br />Ti� � �3 0 .(.. �JU.� - �/ - GZG - <br />naacci .00ncss <br />3���a ��� �t�� <br />PLUMBING <br />NO. TYPE OF PI7(TURE <br />WATER CLOSET�TOILED <br />B�THTUB <br />UV�TORY �WASM BASIN� <br />SNOWER <br />NI7CNEN SINKB DISP. <br />01511 W ASHER <br />LAUNDRVTPAY <br />CLOTHES WASHER <br />WAiER NEATER <br />f1OINNIN(: fflllNi4IN _ _ <br />1 LUGH UNAIN <br />�IUNI SE Ip�Ca <br />'1 OI 01 U4 <br />Lrs � 4J, �J�l v rv t <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS AP• <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE�fjONj{]ACjOiiORr1U7HORIZEDRGEN7 OniE <br />� _ /'_ <br />Ge/� �� <br />♦PPLICANiS CI�Y BUSINE55 LICENSE NO <br />o , .�-� �� 7 <br />MECNANICAL <br />NO. TYPE OF :OUIPMENT <br />AIRCONC. UNIiS-H.P. EA. <br />REFRIGERATIOt! UNITS-NP. EA. <br />�OILERS—H.P. EA. <br />CAS FIRED AC. UNITS—TONNFGE EA. <br />FORCEO AIR SYSTEMS—B.1.U. Ai FA. <br />WALL HEATERS—B.T.U. M <br />UNIT NEAiERS—B.T.U. M <br />EVAPDRATIVE COOLERS <br />CIOTHES DAYERS <br />VENTILATION FAN <br />f14NO1' IIOq❑ <br />.S-/�/ �'� <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />N. A• <br />I .:.,.. <br />OCCUvnNCY( <br />g-2 <br />NO O! S�p1111 <br />VACANi SIIE <br />❑YES xr10 <br />J <br />I <br />'I�CAnurv�cr,liv PL�NSGIIfCNCOUY �PPpfOR155WNGE <br />�,�� �� �.� . <br />PL�N CNEGN NUMBEP <br />� l�USs <br />FEE4 <br />N� iHq��ra .ur <br />ow�oiNc <br />PLUMBING <br />MECIIAN:CA� <br />OTNEP <br />PEN�L7Y <br />TOT�L <br />rEE /4✓ n[t[irf No I <br />1 <br />V�LU�TION FEE <br />s <br />�/ <br />�� <br />