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�ryo.,o,..� ._.PPLICATION FO..� - . .. <br /> everett <br /> CONPERMITT�ON °°e <br /> BI�ILDING DEPAF'fMENT <br /> 259•e�45 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION J�COMBINATION ❑ BUILDING � MECHANICAL <br /> "`7"""� q IA4ILMDRESS / � PLUMBING ❑ $�rN <br /> '_J-C-4�CC/,7, rf.��r.�, GF!'l:'v� �� 35 l��[ { i n fcinrv zic r��oHe <br /> itc�o oi aEn l� V �Q r(KN k'� �/�(!�C 7 ) � .s1/ Y-� <br /> MAll40DPE55 CIiV z�p � <br /> �,n�1�`.J PIIONE <br /> (ilNLIULCUnIH•.;Ipq M�ILp00flE55 <br /> C11Y <br /> ��'J)_{. Z�P PI�ONE <br /> ULENSE• <br /> 1AI GI�NIl,q�,COIi (1�Cipf� MAI�ApUf1E5S <br /> CIIY )IP PIIONE <br /> __/).�L.1'�l . UGENSC . <br /> �'LJMf31 CJ�ipALtOq MqIAUDFCS$ <br /> A 'l /.� P C� �, -z.tiv �,//� C u.� L NNCC�t�(� LUNZ�P�SQ��- 743 di/i ��_E,�::E. - <br /> cussorwaun .�.73— 07.f�[j <br /> �X NEIY U A�GITION � ALTEFATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL,INSERT ��L u �:j%C y (� <br /> :yiumrnorwrnuicosioi unnnini�:rtu,inuoni ❑ �UILOING RELOCA7ICN <br /> �s�--f.-c�-E'� � l�, o�. aa - <br /> :,�.�,�,��, �,�K <br /> Ga,c�-,�Lc,�.T �J� ,� � — <br /> �tii rn xunnun: [L C-S- . <br /> _�� �� � I HEREBY CERTIFY THAT I HAVE REI1D AND EXAMINED ThIIS AP� <br /> �.41015Cf11Pi1U110[pqppEfifV�511pWNpROWORqI11�11fOOfiCO>IES� PLICATIUNANDKNOWTHESAMETOBETRUEANOCORqECT.ALL <br /> I PROVISIONSOF LAWSAND ONDINANCES GOVERNING THIS TYPE <br /> ��� �--�' oioc�or b��L_'--S T� C/'[>.p� D�� � OF WOfiK WILL BE COMPLETED WITH WHE7HER SPECIFIED HERE <br /> � IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PpESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> � . _ ANYOTHERSTATEORLOCALLAWREGULATINGCONSIRUCTION <br /> OR THE PERFOFMANCE OF CONSTRUCTION. <br /> __ SICNA7 .OF C�NiRACTOfl OR FUTNOf112ED AGGHi DAtE <br /> :�n.i�c �.ouncss X G'.�C-t f., ��./G'I'C-�� :� —� S - ��> <br /> APPUCAhiS CItY�USINESS IICENSE NO <br /> ���'�/� 5 -l•L. /��VLr S�Z:. <br /> LUMBING �— (l/ � � �S' �� <br /> T MECHANICAI <br /> N�+�I_� TYPE OF FI%TURE FEE NO. - ---- <br /> ..{_ �WA7ER CLOSET�TOILED iYPE OF EOUIPMENT FEE <br /> � AIRCONO.4JNITS-H.P.EA. <br /> �_ BATHiUB � GEFRIGERATIpN UNITS-H.P. EA. __ - <br /> �_ LAVAiORV�WASHBn51N� CX� GOILERS-H.P.EA. --�"-�"- <br /> SHOWER <br /> / KIICIIBN SINK 8 OISP. H GAS FIRED AC. UNITS-TONNAGE EA -- <br /> � � FGAChO AIR SYSTEMS=B.T.U. M EA. � ��� <br /> /_ DISIIWASNER _ (J'0 NM1i.L HEATERS-B.1.U. M --- <br /> LAUNURYTRAY ___ IJN�IHEAT[RS-B.T.U. M -' <br /> / CLOTHES WASHER � EVAPORATIVECOOLERS -- <br /> f WOIERHEA7ER '�" <br /> U.'IINAL aU � CS.OiHGS DRYERS S <br /> '- VENi�LAiION PAN � <br /> OHINKING FOUNTnIN - -- U`G <br /> -' RANG£HOOD _ _ �s� <br /> _ �LOORDRAIN AIRHAROLIAGUNIT- QF.M. — <br /> ��CUUM BREAKERS <br /> - STOVE —'- --- <br /> (i00F ORAINS-pAINLEAUERS � METAL FIIIGPLACE 8 CHIMNEV <br /> I_ SINK�SERVICE-BAF,ETC.) Z UD WOODSTC��6'/FIHEF�ACE INSERT <br /> -'--_ PEflMOTAL Z � I SUBTOTAL S S-� <br /> s —�-{--�. PENMI7 _f �� -- <br /> _.. __'___ TOTAL FEE S �L.Z (7 I TOTAL FEE f -'—Z- � S-� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> '��'���A��K REARSEIOTCN SIpESETBACR PLqNGNECNNUMpEP <br /> �l"(, � ` ' � / C /' PIANC�ILCnfEE <br /> � � � O� ��v` V rEE�.j� �c n[.eJr•p��/ <br /> .nn. ior�eta <br /> �,� VACANt SIIE <br /> ' � I �IES pN0 FEES VpLUl1T10N FEE <br /> '� ������5� � OCLUPA�lf.VGlIOpP NO.OFOWELLINGIINIIS <br /> ,��- ;,, ,'? . " I - — <br /> -'— ow�owc �l/'�, /- <br /> ^ ������� � NO O(S�OIIIES M�%.OLC.LOAD 5 ' "' �• luS O� <br /> 1 ' � <br /> ' ��� � PWMBMG Z dU <br /> Mff.INlllf.dl .�� 5� <br /> ':I'lllllkl Ill't I11 UIIIIII U I I 11 :: I I NU <br /> OTNER <br /> 'dmu 4IX: pr pLnN5C11ECv.CO AY �PPR FOB ISSOwNCE BY PENRL7V <br /> YOTAL <br /> L �� �;� L , c. , _ —3(��t u <br />