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`�,.-.PPLICATION f0....� <br /> «`�°'"" CONSTRUCTION e <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> zss•s�a5 TO BE COMPIETED IN INK• PLEASE PRINT <br /> ❑OEMOLITION .]COMBINATiON ❑ BUILDINi'a ❑ MECNI4NICAL Q'PLUMBING O SIGN <br /> OWNCN M�IL11DD6ESS CITY ZIP VNONf <br /> (��Mo�+a� Ca.�n�. ���. �333 S��AY B�r.b, r-��iT wa. <br /> UIGaI[f,IOHOf516NLP M�ILIDONE55 CIfY ZIV PIIONC <br /> �:.k ar�r����c� H,�'u% 9Aoo -i//i 3� t�� SF-�t . c�kl, 99ioi 469-/680 <br /> GENfR�LCONIB/.G10R M�IL�OpBE55 GItY 21P PHONE LIGENLf• <br /> T/E /�c� �Nsrtiv�ro�/ �'o. �Eu.G✓vE, r,✓�. C�93-/�7� <br /> MIAl1�NiU1.CONIR�LtOq M�IL�ODRE55 CITY ZIP PMONE lIL[NSf r <br /> �'11I19�N�iCONfR�L�OR M�IL�DpRE55 CIiY IIF ?IIONE LICUR! • <br /> Cl�27�I �N7�F�Z/;Ciie 5 820 l�ti/�D�C A✓E.N, �'�,a. wn. 9B�ay /022-/777 'LZS-J�. <br /> 1E5501 WONK <br /> NEW ❑ ADDIiION ❑ AL7ERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCnTION_ <br /> v��w uon or wonx�Co.•,t Ur uert nu.s riu:Uaoa� <br /> UISCNIUL WO��K <br /> usi ur emion+u <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED Tf11S AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> ur.�totuwnnovovrAooEn�r�S��nwr�nE�owon�ireW�NUnCoriES� PROVISION.`�iOFIAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITIi WHETFiER SPECIFIED 11[RE• <br /> ini_. _eiocK—or IN OR NOT.THE GRANiING OF A PEPMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF <br /> ANV OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNqiUREOFCONIRFCIORORqUiHOP12E0AGENP Un1E <br /> X �--�✓'"�-•l (0 2�/ B�- <br /> PFOlEL1�DORE55 � �PCLI��NiSCIlY8U51NE55LIC[NSENO <br /> ��33 "� p-a,, <br /> P�UMBING MECHIINICAL <br /> NO. TYVE OF FIKTURE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOR6i) AIR COND. UNIT$-H P.EA. <br /> BATNTUB REFRIGERATION UNITS-H P EA. _ <br /> LRVRTORYIWASH BAS�W DO�LER�-HP.EA. —� <br /> —1___ <br /> SIIOWER G/5 FIRED AC.UNITS-TONNAGE EA <br /> NITCHEN SINK 8 DISP FOACED AIR SVSTEMS-B.TD. M EA <br /> DISIIWASHER WALL HEATERS-B.T.U. M <br /> LAUNDFV TRAY UNIT HCATERS-B1.U. M <br /> ClOi.:ES WASHER EVAPORATNE COOIERS <br /> WqTfnryEATER CLOTNESORYERS _ <br /> URINAL VENTIUTION FnN _ <br /> ORINKING FOUtJTAIN RANGE HOOD _ <br /> (LOOR Df74IN AIR HANDLING UNIT- GF.M. _ <br /> VACUUM 9REnKERS STOVE __ <br /> f�UOf DRAIN$-HAINLEAUERS METAL FlFEPLPCE 8 CMIMNEV <br /> PWN�SERVICE-BARETGI WOO�STOVE/FlREPLACEINSERT __ <br /> -- �������� � uc✓en/r� � ---- -- <br /> SUB TOTAL J SU6 TOTIIL 3 <br /> PERM1� t U PERMIT 3 <br /> TOTIIL PEE t J TOT�L FEE S ___ <br /> THIS PORTION TO BE COMPLETED Bl' BUILDING DEPT. PERSONNEL <br /> �i�UNI51113�CN Hf<q5Ci8AGR SIpE5E1B�CK 1`UNGNECNNUNB[P (`I�NCMLChfEI <br /> !C[ �CCUPI NO <br /> �Icl tOAt l0��RU V�C�Ni SIIE <br /> FEES V�LU�TION fEE <br /> ❑YES []NO -- <br /> �rq 01 f.0'!51 OCCl11'n11CYGROUP NO.Of DWElLIN0UN11S <br /> BUILDING = <br /> 1 .�1 111 I.i� Ilii i�l '.liil�ll•I MAt 111:�'. 1 11/��1 <br /> PIAMBM� <br /> MECHPNiCAL <br /> f IRE EiPRINKLERS RECU!�7ED ❑ vE5 O NO � <br /> " OTNER <br /> CEN4LiY <br /> ni�i'I��,;•1•'Jq�LGOv PI�NSGHCCMED9Y ��I`R.fORI55UANCEHV — -- ' -'-- <br /> � TOT�L <br />