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,�.Ew,o,,,� `.,�PPLICATION FG�c� <br />����F CONSTRUCTION <br />everett PE RM IT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />everetl <br />� <br />❑ DEMOLITION ❑ COMBINATION �9 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER M�ILAOORESS CITY 21P PNONE <br />) <br />l'r.d�F�zr 7. Chi�isiti,,<u� i/'i1�9� �YR D�c�sc_ �iY,t'f?�` �iS��'�j ���S�G�,� <br />MLMREGTCFOESIGNER M�ILRUDqESS CIiY 21P PMONE <br />T��.�,•i��',�.� ��t-,,r,n .-�.�,a� .rArK��I�� �±fP�'T!� 4,P�?�.=j =�S:S--.3.�f fl <br />CI1Y ZIP <br />MECNANIC�LLONiq�L10fl M�ILADDBE55 .��N Z�P PNONE LICENSE• <br />PLUMBINOCONtRACIOR M�ILAOORE55 Cltt 21P PHONE LICENSE• <br />CUSS OF WORR <br />❑ NEW �J ADDITICN ❑ ALTERATION ❑ REPA�R ❑ DEMOLITION ❑ WOODSTOVE/FqPL.INSEflT L7 BUILDINC RELOCATION <br />V��U�IIwON OF WORN �COSi OF MAIEflU�S PWS LABOR� <br />V' � J � L' ' � �1 <br />OESCPipE WORN ^ <br />i')r1�1 f_i�.,,��ti l%nn-.,� i�ri/i7-�-1 /�/�iln� A�fJi7Jf.� <br />�or—e�oc�_a <br />� �oo' r!: <br />/C'7/'%_ C)44 <br />8 <br />TRAV <br />_ _ I ORINKING FOUNTAIN <br />USE <br />�� <br />FOUR COPIE51 <br />, <br />I HEflEBY CERTIFY THAT I HAVE RFAD AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIURE OF CONTRACTOR OP AUTHOFI2ED AGEN7 DAiE <br />, � <br />,. -� .[-r � ' <br />, <br />1PPLIGR SCIiY0U51NE55�ICEN5EN0. <br />AECHANIC�I <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERA710N UNITS—H.P. EA. <br />BOILERS—H.P. EA. <br />GAS FIREO 0.C. UNITS-10NNAGE E <br />FORCED AIR SYSTEMS—B.T.U. M E. <br />WALL HEATERS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES �RVERS <br />VENTILATION FAN <br />_ RANGEHOOD <br />/JJ 11/�NIII IN(I IINII.� 1:1 1.1 <br />S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�- n� I � -JY M <br />OFBL00. NO.OFS*JRIES <br />�Oa�) .��G.sF <br />P�ANSCIIELNEO <br />�� <br />pVES <br />MRR OCG LOAD <br />L .G, <br />PLAN GHEGK NUM9Ef <br />�� �r� <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTV <br />TOTAL <br />3-. �L• ,I <br />PUN CRECN LEE <br />FEE l� �ECEIPJ��^ <br />� � /.ti <br />VRLUATION FEE <br />s7�, <br />�� <br />