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J <br /> ,� <br /> � `r:PPLiC�4TiON �0��-' CVe,�,� <br /> � f�e EverDrssn C O N S T'.R l�C f I O N <br /> CITY OF � <br /> � everett PEItM1T <br /> � 70 BE COMPLETED IN BLACK INK— PLEASE FRINT <br /> BUILDING DEPT. <br /> 259•8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEB MRILADORE55 CIiV ZIP PIIONE i <br /> �,� ,� /n25 �1,�N�o.c�i���15 SvG -//o'�/��. � �l�• ��3 -%S�S � <br /> AFCHITEC?ORUESIGt1ER MARAUDfI[SS Gltt ZiP PHONE i, <br /> GENEFALCONTRACTOR kA�LA�DRE55 CIiV ZIP PIIONE IICENSE• <br /> � / i <br /> � �nniie�aP � �.tHccT �On,!;F -1,c•� . �f�i0 i�[�c7'!>`r_'cr.v �CaV �iE?r;i �53�77en dCD�vnICPiqim� <br /> MFCHpNICAL WNTflACTOq IANL AUDFESS Glrv LP PIIONE VCENEE• ' <br /> PL/lI�M01NGCONTRACTORn IdhILA0DRE55 Cltt [IP \ PMONE LIGENSE• �I <br /> I�og�,USn /"'.��mF3%n/l �o'' �� c-- .E . > �D� ,�u'. �%�S�,�u 1 .35s-(�7i _ ' <br /> CrU-�S�SOF WOPI( � � <br /> � lN NEW ❑ AD�ITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOOOS70V[/FRPL.INSERT ❑ BUILDING RELOCATION <br /> ' V/LURTIONOFWORK�COSTOFMAiElilAL5PLI15L�00N� <br /> � `/02� 10 �14 � 0U <br /> UESGRIBE WORIt <br /> /�/C-Zt,l C��oNST/'UC ioit/ - «N/�"cai i -r <br /> use oF nuamNc <br /> �7 n I HEREBY CERTIFY THAT I hIAVE READ AND EXAMINED THIS AP- <br /> � /"f�'lVA7E fSKSi�SENC � PLICATIONANDKNOWT�'�SAMETOBETRUEANDCORRECT.ALL <br /> LEGAlpESCR�'iIONOFPROPERiV�SHOWNdELOWORRTTACNFOIIRCOPIES� PROVISIONSOFLAWSAc�UORDINANCESGOVERNINGTHISTYPE <br /> �" " '' � OF WORK WILL BE COMPLET�D WITH WHETHER SPECIFIED HERE- <br /> �or��o�oc�c..�or�Gu-F<u.I / - . � INORNOT.THEGRANTINGOFAPERNii7DnESNOTPRESUMETO <br /> � GIVE AUTHORITY TO VIOLATE OR CANCEL THt PROVISIONS OF <br /> A Y-4THERSTAT[ORLOCALLAWREGULATINGCONSIHUCTION <br /> � O TH�PERFOR�dANCEp(lF COP!STRUCTION. <br /> SIG TURE� f C011IRAC70R •}�1IT�HORIZEU A NT D�TE <br /> . X L � � � .,_._ L /C(%`�' <br /> PflGJEGiADDRE55 ,�,\ APPLICAN GfY�U51NG SIIGEN5EN0. <br /> � �b'd ?� /C��' • � - _ <br /> PLUM9ING _ MECHANICAL _ <br /> NO. 7YPE OF FI%TUflE FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATER CLOSET(TOILEn � �/� AIR COND. UNiTS-fI.P.EA. <br /> BATHTUB�Sr/OLUEk� CL REFfiIGERATION UNIiS-H.P. EA. _ <br /> ' '� LAVATORIIWASH BASIN) �j�(� BOILERS-H.P.EA. _ <br /> _� Sn0\'iER � C� GAS FI{iED A.C_UNITS=TONNAGE EA <br /> I KITCHEN SINK d DISP. CA I' FORCED Nil SYST[Ng=87_U. M EA. � <br /> DISHWPSHEH � � WALLHE�TGiiS-B.T.U` M <br /> � LAUN�RYTRAY UNITfIEATERS-�.7.U. h1 <br /> CLOTHES WASHEF S EVAPORATIVE COOLEIiS � <br /> W�TER IIEATER CLOTHES ORYEfiS <br /> URIfJAL VENIILATION FAIJ � <br /> DRINI<ING FOUNTAIN fiANGE IIOOD <br /> FLOOR DRAIN A!R HANDLING UNIT- GP.M. <br /> VACUUM BRCAKERS SIOVE <br /> flOOf DRAINS-RAINLEAOERS METAL FIf7EPLACE 8 CHIMNE\' <br /> SINK SERVICE-BAR.E7C. 1N OC IO�VE; I�RF . ACE INSEI7T <br /> (�-k�,+- - D_ <br /> SUB TOTAL "ri' 'J'� SUO TOTAL 5 <br /> PERMIT PERh11T S <br /> TOTALFEE S TOTALPEE S <br /> THIS PORTION TO BE COPvIPLETED 6Y BUILDING DEPT. PERSONNEL <br /> fRON�SET9ACN RE4q5EtBACN SIDESET6ACN PLANC�IEL HU1.10ER PLANLHECNFEE <br /> ,2[-, � ,�� G �'� � � ��,-f �}_ ve��j�!':�� ece�vr no_�o„7� -�!' <br /> ' USEZONE LO7AREA � - <br /> VACAN1911E FECS VALUATION FEE <br /> �_I ��'�') `�VES �1N0 � . <br /> il <br /> ttPEOFCONST. OCCUP}A�NCYGROUP NO.OPOWELll1lGUNITS <br /> � ` • _ � / �UILUING 5 ' �({(�1 � /�1/�1 <br /> SIZE OF�LOG �D- •=+ NO.OV'SIORIES �1�% OLC 1040 -- —i— T s��� <br /> ^ � - NJ � PI.l1Mf31NG ss �b <br /> Mf:C11ANICAL �]� <br /> FIRE SPRINKLERS R[OUIRED ❑ YES ❑ NO ��sG <br /> onie,� <br /> � ne�in�n�Y�..l.l�.I�ll/ — . O <br /> APPLICATIONACC DY PUNSCIIEGiEUOV /-'PR.FORISSUANCEOY �L U�dlCly <br /> . � ^ �, �• TOTAL � <br /> �M <br /> L r.,�� — -- <br /> 10�7 � <br />