Laserfiche WebLink
/'��, � <br /> ;�f�PLICATI(�N FO�� everetl <br /> ��"'p"" �O.NSTRUC��� � O <br /> everett P�RMIT <br /> BUILDING OEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> 7 DEMOLITION ❑ COM8INATION 1j�BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> 1WNE Me1L�DORC34 C�iV ZIP PHONE <br /> � 7 i� p,�dd2� .�CJ /�D T,�/d/� /�,61PGS"//.fL� 9�Z�D- �iSL-06o3 <br /> �PCNIfECIORDE iUNER M�ILII�DRE95 CIIY� ZIP P ONE <br /> S�+v+�. ���''!E/5'`1��� <br /> )ENEMLCONTIII�CTOR M�IL�DDRESS CIIY ZP f pNE � UG NSE <br /> {�j�����/)�pC..: ^�a�) �o /� v�f �(/� mhf�/'� G��il a �s'yOl��. <br /> •IECM�N�CIILCON MCTOB MML�DORE93 CIT � P 1' ONE LCE SE <br /> �LUMlINO CONIMGTOR MMl�DDAE55 Gtt 21� PIIONE IICENSE• <br /> �CL SOiWOXR <br /> NEW ❑ ADDITION ❑ ALTERAtION ❑ REPAIR ❑ OEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> tl1 �TIONOfWORItICO410fM�iE11i�L�CI�/� ���, <br /> � ./ .. �_ - <br /> ocx �ec onK <br /> � <br /> ueeorsunovm /�� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP� <br /> ri471!/L ���-CQ PLICATIONANDKNOWTHESAMETOBETRUEANOCORRECT.ALL <br /> LEJ�LDE9CRiFfqMOSPNOPERrvI5N0 BELOWOR�TT�LNiOURCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ,/ OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �oT_e�ocr_3G_or IN OH NOT.THE GRANTING OF A PERMIT DOES N01'PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUC7ION. <br /> SION�TURE CONTR�CTOPORAUTHORIIEDAGENT OnT' <br /> � �j <br /> .f . Z/�/ / ���J ��� <br /> VIqJELf�DDNE69 ��PUL�N SCIt B ESSUGEN9EN0. <br /> 3 -..S , � �, � , � �I�JE�!'T� <br /> ►LUMSINO MECNANICAL 1 <br /> NO. TYVE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TO�LE ' (7O AIRCOND.UNITS-H.P.EA. i <br /> BATHTUB REFRI�ERATION UNITS-N.P.EA. <br /> 'y ��y�TORY WM1SH BASIN� . n BOILERS-Y.P.ER. <br /> SHOWER ` � �AS FlRED AC.UNITS-TONNRGE E0. <br /> KITCHEN SINKt DISP. U FORCED AIR S�STEMS-B.T.U. M EA. � i <br /> DISHW�SHER � .n WALL ME�TERS-B.T.U. M <br /> LAUNURV TRAV UNIT HEATEHS-B.T.LL M _ <br /> CLOTHES W�SHER �.� hC. EWPORATIVE COOIERS <br /> WATER HEATER <br /> CLOTHESDRVERS � - <br /> URINAL VENTILATION FAN � n <br /> DNINKINO FOUNTAIN RANGE HOUD _ <br /> FLOOfI DRAIN AIfl HANDLING UNIT- C.F.M. <br /> VACUUM BRE�KERS _ STOVE <br /> ROOFDRAINS-RAINLEADERS METAL FlREPLRCEBCNIMNEV <br /> SINK SEHVICE-BAR,ETC. _ WOODSiOVE/FIREPLACE INSERT <br /> I � b.�,/.. �_j+' 1V • ��U <br /> r(�f.) SUB�OTAI � �� � ���� <br /> SUBTOTAL -� <br /> PERMIt f '— PERMIT s . � <br /> TOTAL FEE { -�� '�� TOTAL FEE : ,�� � ��t-7 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> iRONiSEfB�GN RE�RSE1BnCK SIDESEIBI�.GN n Q/� /�/� �] �J <br /> PUNGHECK UMBER ♦ PL�NCN[LR1EE �I <br /> l� � � Ca�S/ // C_JE-� l�4VJ� fEE�/ LI. I�Jp�r�� _ � <br /> � L <br /> USE20NE IOt�RE� y� NTSIiE FEEb VI1lU�TION FEE <br /> ��. � <br /> � ES ONO <br /> ttFEOFCON51. OCGUPnNCYGROUP NO.OFDKELLINpUNliS <br /> U - � .'J - � � au,�oiNc S�_0�� n�n ` SC r <br /> siz[or eioa. r+o or sronies M�x.OGC 10�0 <br /> I ��-' � ;n�, PLUM6ING •C� �1( <br /> MEGHANICAL �..J ��'�� <br /> FIRE SPRINKLERS REOUIRED ❑ VES O NO '�/ � � <br /> OTHER <br /> PE�ULTY / s_v <br /> A�FlIC�110N�CC BY �'UNS C1IEGNED BV �PPR.fOR ISSU�HCE B� <br /> ^� TOT11L <br /> ;� �- . G (a`S ff`' <br />