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�_� <br /> t��PPLICATION f01�- ���,�„ <br /> �TM�ro"'" CONSTRUCTiON � <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEAS[ PFINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBlNAT10N � BUILDINO ❑ MECHANICAL ❑ PL�JMBIN(3 G S�ON <br /> OWN M4ILRODNESS /� CITY ' ZIP � VI�ONE <br /> �i�t�1���1 A��%�� - 1 � i��G �n. ���-�� 9�u� :�s� �9i� <br /> �RCH�I�f GIOB�E91O �fi MAIL�DCRE99 CIIV Z:P P�ICNC ,� <br /> '1'��Tt��lJu�-i71� G.it%Y> �f�/� . `c.�'[�'� �P?LL3 :3:�.3 �c�9/S <br /> 4EN ��CONTRAGTO MAIL�OONE99 � ,� f,ITY ZIP PHONE LICEN9E• <br /> i7�1��1'����� �S�GC . ��/J%(�� . <br /> MECH�NIL�LCONiRACTOq MMLAODRES9 CITY 21P P110NE LICENSE• <br /> PLUMBIHOCONiRACTOP MMLADORESS � GTY IIP PNONE 1.ICENSE• <br /> CUSS OF WORK <br /> ❑ NEW � ADDITION ❑ ALTERATIUN ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.IN�ERT ❑ BUILDING RELOCATION <br /> VALUATION OF WOFK(COSi OF IARIC111ALS PLUS LR�OR� <br />: �5 v,c.�c� <br /> �ESCPI9E WORK � / �7 / <br /> �)U.IL17 �NL� �� � �' ✓`CJ �` "`� L ��,e (--��€'7/ � <br /> u`seoveuamNa - 1 HEREBY CcRTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />� PLICATION AND KNOW TFiESAMETOBETRUEANDCORRECT.ALL <br /> LEUALDESCPIPLIONOFPpOPER1Y�5HOWNBELOWORATTRGHFOURCOPIES� PROVISIONSOFLAWSANDGRDINANCESGOVERNINGTHISTVPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> �or_e�ocK—oF IN OR NOT.THE GRANTING Of A PERMIT DOES NOT PRESUME TO <br />. GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O� <br /> ANY OTHER STATE OR LOCl+L LAW REGULATING CONSTRUCTION <br />'�. ��' /// -- OR THE PERFORMANCE OF CONSTRUCTION. <br />�' 1 G� n� .�/ � \ � I/ - ^— SIGNATIIPE Oi�CO Tf�CTOfl OR AUTHORIZED AGC�M DATE <br /> ���_i ("X 1V t 'I / /. <br /> f x �c i '/ .�� L�iiY'f� <br />� --- <br /> ?FOJECT AUGPES9 APPLICANiS CIiY BUSINE55 UCENSE NO. <br /> I <br />, I ���t I`��" a���E . S.�' . �EJcu:7 <br />� PiUYA81N� MECHANICAL . <br /> iNp, TYPE OF FIXTUflE _ fEE NO. TYPE OF EOUIPMENT FEE <br />� _ WpTER CLOSET�TOILEp __ A�F7 COND.UNITS—H.P.E0. <br /> I BATHTUd PEFRIGERATION UNITS—H.P.EA <br /> i LAVATORV�WASH BASIN� BCILERS—H.P.EA. <br /> SHOWER GAS FIRED AC.UNI!5—TONNA!?�EA _ <br /> F KITCHEN SINK 6 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHEfl WALL HEATERS—B.�.U. M <br /> LAUNDRYTRAV UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE CDOLERS <br /> WATER HEATER CIOTHES DRYERS <br /> UflINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD • _ <br /> FLOOfl UflAiN AIR HANDLING UNIT— C._��i. <br /> VACUUM BREAKEPS � STOVE <br /> ROOF DRAINS—RAINLEA�ERS METAI FIREPLACE 8 ChIIMNEY _ <br /> SINK SERVICE—BFR,ETC. WOODSTOVE/FIREPLACEINSERT <br /> I SUBTOTAL SUBTOTAL S _ <br /> PERMIT S PEPMIT 3 <br /> TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FOONTSEtBACN �ERRSEI�ACN SIOESEi00.CK PLANCMECKNUM9ER PIANCHECNFEE <br /> Q O c1 fEE H[GE!FiNO. <br /> USE20NE �OIRfi[A yq�pN SIfE <br /> �, '1� N Fl . OYES�Q��O FEES V�IUATION FEE <br /> L <br /> TYPEOF jSi. , OCCUPAIlCYG�OUP NO.OFD�LLLINGIINIt9 <br /> I <br /> 77 N M eui�oiNa s <br /> SIIE OF BL�G. ��OAP SIORIES b�AX.00G LO�D <br /> �� <br /> __. _�- PWMBING <br /> MECIIANICAL <br /> FIRE SPRINKLERS FiEOUfPED ❑YES Ip jj6_ <br /> OTHER <br /> PENALTY <br /> �FP�ICAlIOHACC.BY PLANSCHECKEDOY� FPPp.fORISSUANCEBY <br /> TOTAL <br />' �1 c�' � - <br />