Laserfiche WebLink
ryE�,,,,, �t�1PPLICATION FOK � • , � -�.y�,�„ <br /> CONSTRUCTION <br /> everett PERMIT � <br /> TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> 3UILDING DEPT. <br /> t59-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUM8ING ❑ SIGN <br /> 1WNwERY """���111 A `�' MAIL�DORESS /J� Cltt 21P PHONE <br /> 3.L�iYI/JLLGI—A,{— ""� S MA A�Ofl 9�L%•�C��� �D��IY/LIP ��!/�/ PHONE G��^��I 2r <br /> 7 <br /> nLNIIEGf OR OE91aNER� � <br /> L- <br /> .ENER/�CONfH�CTON� ��ILADDNE39 Cltt 21P PHONE LICENSE• <br /> � r�/!���i�:'C. � Gf/,>�/�� i/lL ./���« <br /> .�LGN�NiC�ICONT Oq MAILAppR S GITY ilp PMpNE ICENSE• <br /> 'LUMBING GONTMLTC'R M�IL�ODRESS CI�/I /" ZI�—" � �O � LICENSE• <br /> �l�S OF WORN <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ RE�AIR ❑ DEMOIITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br /> �„��,����,l���ct��',�•,.—�j��,�r� <br /> 4 C IBE WO/R�R�\ � Cl�-{' . . <br /> �� c�.�J��� Y' " /Y'-l�. --'� . <br /> ur.or aoiHc% � _ � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> / PLICATiONANDKNOWTHESAMETOBETRUEANDCOFRECT.ALL <br /> � IiO�LDESC IIONOFP PERTY�SNOWN e�ow �TT�CHFOUPCOPIES� pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED�1ERE- <br /> . ur �oc�_or IN OR NOT.THE GRANTING OFA PERMITDOES NOT PRESUDAE TO <br /> / GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOM1S O� <br /> ` �. GLL �-l�•� � G 'G� ANYOTHERSTATEORLOCALLAWREGULATINGCONSTRUCitON <br /> OF THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATU OF CONiRACTOR OR AUTH ED AGENT DATE <br /> 'D—z — z8 -4 � �' z f� <br /> 'ROJECf�00RE55 q A . ICR PSdTYBU91NE55LICEN5EN0. <br /> ! �� Q.� 7 ;/ � � <br /> . �LUMBIN6 MECHANICAL <br /> TVVF.OF FIXTUNE FEE NO. TYPE OF EOUIVMENT FEE <br /> WA7ER CLOSE7�TOILEn �b AtR COND.UNITS-H.P.EA <br /> BF.TH7UB REFRIGERATION UNITS-H.P.EA <br /> � I.AVATORYIWASH BASINI BOILER�H.P.E0. <br /> SHOWER GAS FIRE�AC.UNITS-TONNAGE EA <br /> �_ KITCHEN SINN 8 DISP. � FORCED AIR SYSTEMS-B.T.U. M E0. ' QO <br /> DISMWASHER OtJ WALL HEAiERS-B.i.U. M <br /> / IAUNDRYTHAY !b UNITHEATERS-B.T.U. M <br /> � CLOTHES WASHER (`.� EVAPORATIVE COOLERS <br /> WATER HEATER � CLOTHES ORYERS SU <br /> URINAL VENiILATION FAN Od <br /> DRINKING FOUNT4IN RFNGE HOOD $O <br /> FLOOR DRAIN AIH HFNDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOFDRAINS--R4INLE�DEFS METALKIREPlACEB CHIMNEV <br /> SINKISERVICE-BAR.ETC. WOODSTOVE/FIREPLACEINSEFT <br /> 1 —� — - .� <br /> SUBTOTAL SUBTOTAL 3 � C7 <br /> PENMIT f PENMIT S <br /> TOTAL FEE f 10TAL FEE S S `.+�� <br /> THIS PnRTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �IONISF.Ipnf.N flEnflSf.IHnCn SI�ESE FCN PLANCHEL UMBER PI�IICMECNFEE <br /> ��r-2o- —� 2�' `�'�'�iF=i �� y9y3 FE� �s NECLIPiNO <br /> 'iE 2� lOi R�IErI o yqC�NT SITE <br /> �S� Z� SDO ��ES ONO FEES YAIURTION FEE <br /> �NE�`SI OCCUPA��iROUP NO.OFO�LLIN�ONIT9 BUILUING S` ��� �.�0 /'� <br /> i[E OI'O/DG� NO.OF SIOPIES MAX OCG LOAD v <br /> 2/8 �r.' / �- PLUMF7ING � C(�� <br /> MECNANICAL 3 � <br /> IRE SPRINKLER$REOUIRED ❑YES NO <br /> OTHEP <br /> FENALTY <br /> �'VUC�IION ACG.BY PL�NS CIIECNEO BY �PPq.FOR I55U�NCE BY ,( <br /> ��� J�/! � G ,� TOTA� -5 (/ � <br />