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a�,,,�,,,,, `,..PP LICATIO N F0.1 �,�,„, <br /> CONSTRUCTION 0 <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259�8�45 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOlIT10N ❑COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING O SIGN <br /> UWNlR MML�ODFE55 CITY bP PHONE <br /> r .«� 7.��� n:ir,�1. __ 4B .3o ��-���s� EU..r._�� iS•30C ,T5`.� C- f� `6' <br /> ���C.nntC�onp�s�cNfn MUL�D�nESs C�Tv Lr opoN[ <br /> �.INUUIWNINeG�OR MMl�OD11E/55 / CIIY ZIP PI�ONE IiLtNti1 � <br /> G ��_' catiConse..,,,-I:.�� �uns<�I:�Y.S /.53/o.Smo�L.,/������/GrrMsvf S�Ba�o � Sg-'l357 �r5i,��� <br /> I�ICIUNif.4G 1 �CIpR M�IL�DDf1E39 GIV IIP P110Nl. IICENtiI • <br /> �IUMpMM1GON�R�C10R MAIL�ODRE55 CItY 21P PIIONC tICENtit• <br /> f1�55O�W011e <br /> ❑ NEW � ADOITION ❑ ALTEFATION ❑ HEPAIR ❑ UEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING REIOCATIUN <br /> vqu���nnnr WOn��f.p5�or1AnIl.Nnl5n�u5Ueory <br /> J�r�J O '7 — <br /> ❑1 9f,n�qt wryln <br /> G-t�C � �G P �Ca� 5•,� t�.-1 �,.'v.—_ . <br /> usi ur ounnum <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> �'"riO �� ��'^^ � • PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> iir•imscruruovoronorentrisrrownneiowonenecHvouncomesl pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> �o�_eioc '�'' or OF WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HERE- <br /> IN OR NUT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORIiY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSIRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNAiUNE OP CONIRnCTOR OR RUTNORIZED nGENi � 04IE <br /> X � �7 . �� �0 ' �(O ' C�j� <br /> n110JCCt�DONE55 �PPLIG�NTSL`IY SINESSLICENSENO <br /> °� x��� S...��,_.-s-1 � vF S5a�.3 <br /> PLUMAIN6 MECN�NICAL <br /> NO. TYPE OF FI%TURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WAIER CLOSET�TOIlEO AIR COND.UNIiS-HP.EA. <br /> BATHTUB REFPIGERATION UNIIS-H.P.EA. <br /> LAVATORY�WASN BAS�N� DOILER$-HD.EA. <br /> SHOWER GAS FIRED A.C.UNIIS-TONNAGE E�. <br /> _ KITCHEN SiNK 6 DISP. FORCED AIR SYSTEMS-B.T.U. M EA. � _ <br /> OISMWASHER WALL HEATERS-B.T.U. M I <br /> _ — 1_'_._ <br /> LAUND(iY TqAV UNIi HEATERS-B.T.U. M <br /> CLOIHES WASHER EVAPORATIVECOOLERS <br /> W�TFRIIEATER CLOTHES DRVERS <br /> URINAL VENiILATION FAN <br /> DRiNkING FOUNTAIN RANGE NO00 <br /> �IOOR DnAIN AIq NANDLING UNIT- CJ'M. <br /> VACUUM BRERKERS STOVE <br /> ROOF DRAINS-RnINLEnDERS METAL FIFEPIACE 8 CHIMNE+ __ _ <br /> SINK�SERVICE-BAR.[iC. WOODSTOVE/FIREPLACE INSERT _ <br /> SUB TOTAL SUB T0TI1L f _ <br /> PERMIT � FEPMIT f _ <br /> TOTRI FEE t TOTRL FEE f __ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �I�Ui1154104f.h �1LMS[I9�GN SIOESEIB�CIt PL�NCNEGNNUMBF.R �IMICNCCK�I[ <br /> �f�� •.-.��1 � � ���1G� 9� rcE��3�, n� �rtFl�� <br /> usivovr ioi�nc• vec�w sre <br /> fEES V�LWTIOH iEE <br /> �1 OVCS O .p. n - ---- - -- <br /> �n•iu1icoNsi occurnr�crcnour Ho.oroweuiNourvns . Gi [ �UDI.IJ`61f�1 �/ Ly�'_ <br /> �/ � ��� I� -`1 ' BWLDING sz�' v (�,/ <br /> �V(.UI plpt: �/ NU Of SIOflI[3 M�kOCC.lOAO <br /> � •py) �J�p1R- PLUMBING _ <br /> MEGIIANIGAL <br /> fIR[SPRINKLERS RCOUIRED 1] YES O NO � <br /> OTIIER <br /> PENRLTV <br /> nPP1iC�1�UNACf, OY 1'LANSCI�LCKEDBY �PPqfOPI55UANtEBY �- <br /> � � <br /> G �. .o,.� --`�� - - <br /> s� <-� <br />