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,,.. C <br /> I�sEverpieen ��Y��PP�ICATION I�Oh�'� everetl <br /> ����F CONSTRUCTIOPI � <br /> everett PERMIT <br /> BUILDIMG DEPARTMENT <br /> 259-8�45 TO BE COMPLETED IN IfdK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION �SBUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILAOORF.55 GIiY n��l/1O ZIP PHONE <br /> '1 �J�- J <br /> � I�� �n�� �,i- l'�5���. ��)�'=` a�r�� ��. ���er � �-� -cz�l� <br /> 1RLNIIEC ORD[SIONER MAILF�ORESS CILY 21P PNONE <br /> GENERAI CONLR�CIOR MAIL ApURE55 CItY ZIP PIIONE UCENSE• <br /> �'(:l 111 i% <br /> IAEGNPNIC<L CONLnAC10B MnIL nODRE55 CIIY ZIP PNONE LI�ENSE• <br /> PWMBRIOCO��IIUCICA M�IL�ODPE59 CIIV IIP PIIONE LICEN9E• <br /> cOssNEWor� ADDI110N ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOC�TION <br /> VALU TON OF W09K�C091 0F lAAIE RIALS PLU9 UBOR1 <br /> ��� ��(�(7 l)(� <br /> oEscniuE wonK <br /> - t C V= ' -- <br /> use ov euiion+a I HEREBY CERTIFY TIiAT I HAVE READ AND EXAMINED THIS AP- <br /> �O��I( . C"CLU11�U I��,l)L���I��!� � � I PLICATIONANDKNOWTHESAMETOB[TRUEANDCORRECT.ALL <br /> IEG�L0E5CRIPiIONOFPflOPEBY�SNOWNBELOWOBA ne��rouneories PROVISIONSOFLAWSANDORDINANCESGOVERNINGTNISTYPE <br /> <7 ' ' ' V I ! � C. OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> �or '_� eioc�—ov�` � INORNOT.THEGRANTINGOFAPERMITDOESNOTPRFSUMETO <br /> GI\'E AUThIORITY�TO VIOLATE OR CANCEL THE PfiOVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONATURE OF CONiBA�TOF OR AUTHOPIZE�AGEN� DAIE <br /> X �. , 1'\ C�:ll�l2., � �.Q- � -t4�l <br /> VROJEGT AD�RE55 APPLICONTS CIIY pUSfNESS UC[NSE NO <br /> C :�l � -Ili � _ �: <br /> PI.UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�iOILEA ����COND.UNITS—N.P. EA. <br /> BAtM7U0 REFRIG[RATION UNI7S—N.P.EA. <br /> LAVATORV�WASH BASIN� BOILERS—H.P.EA. <br /> SHUWER GAS FIRED AC.UNITS—TONNAGE EA <br /> NIiCHEN SINK 8 DISP. FORCED AIR SYSTF.MS-81.U. M EA. <br /> GISHWASHEfi �M1'ALLHEATERS—d.T.U. M <br /> LAUNDRY TRAY UNIi HEAIERS—B.T.U. M <br /> CLOTHES WASHER EVAPORAT{VECOOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> Uf71NAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HO00 <br /> FLOOR DRAIN AIR HANDLING UNIT— GF.M. <br /> VAWUM BREAKEf75 STOVE <br /> ROOF DRAINS—RAINLEAUERS METAL FIREPLACEB CHIMNEV <br /> SINK�SERVICE—BAR,ETC. WOODSTOVE/FIREPLACEINSERT _ <br /> Sll�TO1AL SU9 TOTAL S <br /> PEIiM1T 5 PEpM1T 3 <br /> TOTALFEE 5 TOTALFEE S _ <br /> THIS PORTION TO BE COMPLEI'ED BY BUILDING DEPT. PERSONNEL <br /> �RONfSEIpACK BF.4RSEIpACK SIpES[i�ACH �IANCHEG NUMBEfi PLnNGMECNGEE <br /> �� I4 f� L FEE I )C /�rJ AECEIPTNO.� I�)� <br /> �� � � <br /> USE ZONE LOL nREA ypCARi SIIE <br /> FEES VALUATION FEE <br /> C1YE5�(FJO — <br /> � � <br /> fYVEOfC01lSi. OCC11�n�1CYGROUP NOOFOWEIUNGUNIfS <br /> �,-�' �– / $_ OUILDING � � <br /> size or oiuc p�elC r+o or sew�nies rAnz occ iono/� <br /> ..n� �1 /✓.A/ N �y I PWM1161NG <br /> MECH4NICAL <br /> FlRE SPRINKLERS REOUIR[0 ❑ YES NO <br /> OTHER <br /> PE4ALTY . / - <br /> APPIICAIIONFCC OY PLNISCIIELNEOUY avrn �ORISSOANCEBY -- - <br /> �� � y� TOTAL 6 <br /> _ _� _ _. __. _ _—__ . . . � � :.. ' _ '—' —_ __ � <br />