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' . .PPl.ICATION FC .. ��e,�„ <br /> '".E".,°'"" CONSTRUCTION 0 <br /> cin os <br /> everett PERMIT <br /> DUILDING DEPARTMENT <br /> ?59•8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> 7 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> :NNEH MAIL�OOPE45 CIIY ZIP PIIONE <br /> L n/Z f ��V t2�9T/'��'i`,S' i/Gi9 ��'i2d S •l= C v �<<i� ���1��;� `,�•� <br /> 9GNRECTOPOE910NER M�ILAO RESS CIIY 21 P ONE <br /> ?5� -��,s` � <br />� �E��ERAL GONIR�CTOR M�II AOORESS CIIY ZIP PIIONF LICFNSE• <br /> 2LIUNIC�LCON�R�CtOH M�IL�UOIIE55 CItY LIP PIIONC L�C[Hi[. <br /> LUMBIN�)COIItP�CtOR M�I��pDRESS CIIY i1P �IIONC LICENY!• <br /> I .USSOf WOPI: <br /> ❑ NEW ❑ ADDITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLJNSER7 ❑ BUILDWG RELOCATIOtI_ <br /> �Lu�rloN of woAK ICosf O�M��En�n1.51'tu5 LnooRl <br /> ��r�iil (/ �) <br /> (%��_ <br /> ESCRiBE WORK <br /> �,t](�//II( i.d/# L. <br /> SE Of BUILD�iiO n <br /> �V I Z I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS AP� <br /> 1,�.y{���F�• .! ..�-� �-N;�"�t"� ' �V�?c tpLICATIONANDKNOWTHE5AMETOBETRUEANDCORRECT.ALL <br /> ��JAC�ES�NP�IONOiPROPLOtYi5�10WilOLLOWOOR�I�GMfOUf�COPiCS1 pqOVI510N50FLAWSANDOFDINANCESGOVERNINGTHISTVPE <br /> OF WOFK WILL BE COMPLETED WITH WHETHER SPFCIFIED HERE- <br /> i�_eioc�—or IN OR NOT.THE GRANTING OF A PEflM1T�OES NOT PRESUME 7U <br /> ` / y �U� GIVE AUTHQRITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> X � aE� -U ANYpTHERSTATEORLOCALLAWREOULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGN4TURE OF CONTRRCiOB OR AUIMORIZED AOFNI OAtE <br /> � l�'l'OL'—�al�� J •—,�U .�U <br /> QOJECT�DDRESS ♦p LICAN SCIlYBU51NE55lIGEN5EN0 <br /> � 2 i�a E �vE � <br /> 'LUMBINU MECHANICAL _ <br /> NO. TYPE OF FIXTl1RE FEE NO. TYPE OF EOUIGMENT _ FEE__ <br /> WATERClOSET�TOILEA � AIRCOND. UNITS-H.P.EA. <br /> BATHTUB REFRIGERATION UNITS-H.P.EA. _ _ ____ <br /> LAVATORYIWASH BASINI BOILERS-H.P.EA. _ _ <br /> SHOWER GAS FIRED AC.UNITS-TONNAGE EA. _ <br /> KITCHEY SINK 8 DISP. FORCED AIR SVSiEMS-B.T.U. M EA. __ <br /> DISHWASHER WALL HEATEPS-B.T.U. M __ __ ___ <br /> LAU�'JRYTRAV UNIiHEATERS-B.i.U. M ___"__"_ <br /> LL6THES WASHER EVAPORATIVE COOLERS __ <br /> WATER HEPTER CLOTHES DRVERS __ __ <br /> URINPL VENTILAiION FAN __ _ <br /> DRINKING FOUNTAIN RANGE HOOD _ <br /> FLOOR DRAIN AIR NANDLING UNIT- C.F.M. ___ <br /> VACUUM BREAKERS STOVE _ _ ____ <br /> ROOF ORAINS-RAINLEADERS METAL FIFEPLACE 6 CHIMNEV __ __ <br /> SINK ISEFVICE-BAR.ETC.1 WOODSTOVE/FIREPLACE INSERT __ ___ <br /> SUB TOTAL SUB TOTAL S _ __ <br /> PERMIT S PERMIT __ S _ <br /> TOTALFEE f TOTRLFEE 3 ,_ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �ONISEfBRCN RE4NSEIpRCN SIGESEIBRGN PLANGMECNNUMOER f`1.4NCNECnf[E <br /> �EE AECCI�1 NO <br /> iEZONE LO���IIA VqL4Ni5RE V�LU�TION fEE <br /> FEES <br /> ❑YES ONO <br /> � E OG L0��51 OCCUnnrlGv GOOUP NO OF�WELIING UNIIS ___ <br /> BIIILDING f <br /> )E Of BIOG ND Of SIOmES Mn% OCG lOaO — <br /> PLUMBING <br /> AIECIIANICA� <br /> iRE SPRINKLERS REOUIRED [I YES O NO <br /> OTNER <br /> PENALTV <br /> PIIL�IIONRCf, OY PUIlSGIfCKEU1IV APPIIFORISSURNCEflY - - I <br /> TOTAL <br />