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, .PPLICATION FO►_ ���,�„ <br /> fMEwrprNn CO N ST R U CT 1 O N <br /> Cltt OF � <br /> everett PE RM IT <br /> BUILDING DEPARTMENT <br /> 259-87a5 TO BE COMPLETED IN !NK- PLEASE PRINT <br /> G DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER M�ILADDflE55 Gltt ZIP fHON[ <br /> n�n�-tr�.�� (`or+�Y- 171C »f� 6. U�s{,� Oel ✓cni7,� N17MPtl0 LS 9�2�iL 65Z —OS�S <br /> •B1:1111iL1pliDFSIGNER MAILAOORE55 CIiY TIP PIIONL <br /> .IlYl�2�esSio J ��+.. ��L� . �oic../'r- _ <br /> .cnu�ucon�n.c�oa M•unoon�ss cm zir ruor+t ur.uis� . <br /> »n�+7'f�Sc��VRa:.�h �11G isG E. v��i. M�e/ M�3+C Ci4vnww0 ZS �jS's?y2 619iaTrEeri� ;�.ia <br /> Mlh11NIC�1 CONiR4ClOp MAILAppflESS GIN 2iP PIIONL liClbSl � <br /> 17c() �'fa �-F- DJL iL zG,�,rny <br /> VLUM�iN.CONIpAC10H MAILAD�RE55 CITY ZIP PIIUNI ULLNS! � <br /> .�►�r 3 i/u>N�,1, y — -- J w y s P 31 I o �r <br /> cuss o�woa�— ' <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCaT10H <br /> V�IUAIION OF WOPN IWSI Oi IAAICRITLS PLUS LABOflI <br /> "5[��C9d0 <br /> ncsenine woNK <br /> C x.3 � <br /> use o�nmioiN,/c� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP� <br /> sl.J 1�'p PLICATIONANDKNOWTHESAMETOBETRUEANDCORf,ECT.ALL <br /> l GnlDE5Cf11PLiON�FPFOP:PtYISHOWNOELOWORR1iPGMFOl1PCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �oi�e�oc�_ov��`� 2 � INORNOT.THEGflANTINGOFAPERMITDOESNOTPRESUMETO <br /> GI\E AUTHORITY TO NIOLATE OR CANCEL 1rIE PROVISIONS OF <br /> W.ps,{ c���y p�` ANYOTHERSTATEOflLOCALLAWREGULATINGCONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CON7RACTOF OR Al1i110flIZED aGENt pA7E <br /> M--- 4 �;-��.,,._ 3 25 <br /> 1'POJEC1eDORE55 /P ICA 1'SCITY9USINESSLICENSENO <br /> .. � , c6F\ �� � �, / Sr(�Fr5 <br /> PLUMBING MECMANICAL __ <br />� NO. TYPE OF FI%TUHE FEE NO. TYPE OF EOUIPMENT FEE <br /> IWATERCLOSE�ITOILE➢ AIRCOND. UNITS-H.P.EA. r <br /> flEFRIGERATION UNITS-H.P.EA —+ <br />� �aTHTU6 -- — " <br /> i _ LAVATORYIWASMBADIIJI BOILERS-H.P.EA. -' .___ <br /> SHOWEP GAS FIRED AG UNITS-TONNAGE EA ____ <br /> I _ NITCHEN SINK E DISP. FORCED AIR SYSTEMS-B.T.U. M EA. _�_ _ __ <br />� , DISMWASHER WNLL HEATERS-B.T.U. M _ _ <br /> i LAUN�RYTRAY UNITHEATERS-BT.U. M _ ___ .__ <br /> CLOTMES WASHER EVAPOflATIVECOOLERS _ ___ _ <br /> WaTER MEATER CIOiHES DRYEFS _ ____ ____ <br /> I �R�Np� VENTILATION FAN _,_ �„__._ <br /> DRINKING FOUNTAIN RANGE HOOD .___ _ __.__ <br />� FIOOR ORAIN �IR HNNDLING UNIT- C.F.M. ___ ____ <br /> VACUUM 9REAKER$ STOVE _ ___ ____ <br /> ROOF�RAINS-RAINLEAOERS MEiAL FIREPLACE 8 CHIMNEV _ ______ _ ____ <br /> SiNNISEPVICE-BAR,E7C. WOODSTOVE/FIREPLACEINS[RT __ _ _ ___ <br /> S118 TOTAL SUB TOTAL f _ ____ <br /> PERMIT . S PERMIT__'_ t. ___'___' _ _._ <br /> TOTALFEE f TOTALFEE _S ________ _,___ i <br /> THIS PORTION TO BE COMPLETED BY BUI�DING DEPT. PERSONNEL I <br /> fRO�rtSEIp>Ln BEAfl5Ei0nCK $IOESETBACN PLANGMECNN/q,MBER P�A���°«^�E� �, <br /> �/ //��Y iCE�`l, � IiLG[IPiND --- . <br /> 4�� <br /> ❑SC:ON[ LOIAREA y�CANT5ITE • <br /> FEES VRLURiiON FEE <br /> �YES ONO — '--- <br /> tVP[OfCON51 OCCUPANLVGROUP NO.OFDWCLLINGL'NI15 <br /> BUILDING s <br /> 512t OI 011lti NO OF SIOliIES MA% OCC.lOAO <br /> PLUMBING <br /> h1ECMANICAL <br /> FIRE SPRINKLEFS RE�UIRED ❑ YES ❑ NO <br /> OTHEH <br /> PENALTY <br /> AVPIIGc�i011<f.CtlY PLdNSCMECNEDBY APPRFOqI55UANCEBY I I <br /> TOTAL _ _ --l____- I <br /> '� . <br /> ��� <br />