Laserfiche WebLink
MeEr�ryrNn t�PLICATION ��F,...� everen <br /> c�TMO� CONSTRUCT��J�I � <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION ,�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWf1EP M�IL�UORES$ CITY ZIP PNONE <br /> t <br /> d�J r'/Z�c i d�^ <br /> �RLMIIEGIOROESIONEN MMI�DORE59 Cltt ZIV PNONE <br /> 4ENEPntCONIRUGION MAILAODRE55 C17Y ZIP PIIONE IICEII[E• <br /> ,(�[c', Cc: � �Ol.�= J NG �/S?�I /3 �''� i�C . r.t' . tsv�iE-// u�� . �,:�c �2 iyS83�s aLF� �s�nyn,� <br /> MF'.�I�NIULGON1RALiOq M�ILAODNESS � CITV Z�P PNONE I.I�FNSE� <br /> PLUMBIN.CONIRACipR M�I��OORE55 CIiY 21V PIIONE LICENSEv <br /> C1�550�WORn <br /> �. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRPL.INSERT ❑ BUILDING RELOCFTION <br /> vsiwnoHorwonKicosig ?nrznie�srius�neoni ��, <br /> 5�—caa-a =��1; F-�2'�• <br /> �,��,,,��;,,o„K <br /> a.•ew c�� tr�K�� � on, <br /> use or ewwwc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> � �n%• L F m:�Y' �E•S' PLICATIONANOKNOWTHESAMETOBETRUEANDCOFRECT.ALL <br /> iiunioesc iPIWNOFPNOPENfY15 wN IOWOR�ti�CHFOOFCCPIE51 PROVISIONSOFLAWSANDORDINANCESGOVEflNINGTHISTYPE <br /> 9F OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �o��e�oc�_ov IN OR NOT.THE GRANTING 7F A PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF <br /> ANY OTFiER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUflE OF CONTRACTOR OF AUTHUR12E0 AGEN7 DaTE y/2 aJ&6 <br /> X � � ) <br /> PHUJELI.IUORESS /`J � ' �� nvrucaNrscirve INESSLICENSENO <br /> �o ri` ,v b .3 �° Fl vE <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FI%TUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(701LEn Qrj Alp CQN�. UNITS-H.P.EA. _ <br /> �. BAiMTUB REFRIGERATION UNITS-H.P.EA. _ <br /> LAVATORVI�'�'ASH BASINI BOILERS-H.P.EA. __ <br /> SHOWER GAS FIflED AC. UNITS-TONNACE EA __ <br /> KITCHEN SINK 6 OISP. Z W FORCED AIR SYSTEMS-B.T.U. M EA. <br /> I DIS��WASHER ' LYJ WALLHEATERS-B.T.U. M _ <br /> LAUNDRV TRAY UNIT HLATERS-B.T.U. M <br /> --7� CLOTHES WASHER EVAPORATIVECOOLERS <br /> 1 WATERI1EAiER OD CLOTHES ORYERS � <br /> UR�NAL �J VENTILATION FAN __� C1D_ <br /> DRINKING FOUNTAIN AANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. __ <br /> VACUUM BREAHERS STOVE _ <br /> RDOF DRAINS-RAINLEADERS METAL FIREPLPCL 8 CHIMNEY <br /> SINN�SERVICE-BAfl,ETG WOODSTOVE/fIREPLACEINSERT _ <br /> SUB TOTAL C�"� SUB TOTAL S �3 �a <br /> PEPMIT • '� PERMIT 3 '"' �-�—l- <br /> TOTAL FEE 3 � TOTAL FEE S �3 S y,� <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> i11UN1iL10RCn RWRSEIOACN SIDESETBACN PL<NCHECKNUM�FR PIANLHECNGEE <br /> ���� ♦ -'� � , (p � � /�(/�� FEE /��=.1 REC[i�l l�/J� — <br /> Uti� [pNE lUf AfiFR 7 �j � <br /> VAC�NTSITE FEES V�WJ1710N FEE <br /> �•\)_ I " (' ( "'� ES ONO — <br /> � <br /> Ivi'COfLONSi OCCUPPNCYGBOUP NO.OiOWELIINGIINIIS <br /> V '� � � - J I BUILDING SS �S vV <br /> tillf ol Ui OG NO U!SIOnIES M�lL OCG.LO�D — <br /> PLUMBING � <br /> MECNANICAL ��3.J Sa <br /> IIRE SPRINKLERS REOUIRED ❑YES ❑NO <br /> OTHER <br /> PEYALTV <br /> aVP1iCnliONnGf, Bv FL4NSCNEGNEDBY �PPH.FOqI55U�NCEBY L <br /> TO7AL 3� J� <br /> � �•� � � <br />