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�MErop-wn `�+PN�ICA''iOM �f0,� <br /> CITY OF C O N�T'tt �tJ C'f I O N everetl <br /> everett PERMIT � <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE �,OMPLE'PED IN INK• pLEASE PRINT <br /> ❑ DEMOLiT10N ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ P�LUMBING ❑ SIGN <br /> JWNEN MAIL�ODNE55 Cltt ZiP PN9N[ <br /> ,r, -� 2/70 � 7/-.�, .��1� ! � �O�/ ���—G� � � <br /> q . t .c�ti : ) �LS'C/�-!C'�'/r- f-'[�r� Ze U � <br /> A1IGNIIECIOPUESIONEP M�ILApOqE35 CITY ZIV PNON[ <br /> �y <br /> QEN[RALCONIP�CIOR MRIIADOflESS Cp'� ZIP PIIOYE UCEI^uE• <br /> _�'� <br /> MECHINIWLLON1RnCiJq MRILADpRE55 •Cltt 21P PNONE LIpENS[• <br /> ��. <br /> PWMBiN4GONiA�CiOR MMl.AOdqE�9 CITY LIP PIIpNE LILENSE• <br /> � <br /> ♦ <br /> CI�SS OF W011N — <br /> ❑ NEYJ ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION � WOODSTOVE/FRI'L.INSERT Ll BUILDING FELOCATION <br /> VAWR�IDN OF WORN�COSi Oip MRfEfiIqLS PlUS LABOR� ��' <br /> /�J i �� <br /> DESCf11pE WONN <br /> ,t;c:<��'A c,��ri�v ar�. �i`c�._ �-- ,U, �.v ,� <br /> useovewiovue - -�1-�-� '��`r'S� <br /> I HEREBY CEP,fIrY TFIAT I NA�/E REA� AtJh EXAMINED THIS AP- <br /> PIICATION AND KNOW THE SAME TO BE 1qUE AND COARECT.�LL <br /> LEOALOESCPIPIIONOFPROPEPIY�SNOWNBELOWONAITACHFOURCOPIES "''-JVISIONSGFLAWSANDORDINANCESGGVERNINGTHISTYPE <br /> OF WOqK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br /> ior " eioc�oc INORNOT.THFG�ANTINGOFf�PEHMITDOESN�TPRESUMETO <br /> uIVE AUTHORITY TO VIOLl�TE qR CANCEL THE PROVISIONS OF <br /> ANV OTHER STrTE GA LOCAL LAW REGULATING COlJSTRUCTION <br /> OR THE PERFORMANCE OF CONSTqUCTION. <br /> �X ��� -�S7Sl�C��r�-�7q-Ooo �IGNATOREOFCONTNACTORORAU7HOFI2EDAGENT DATE <br /> X /,-GiCI�/P��l—�f�..J-'N-���f� (�� /�-tJ� <br /> PqOJECi�00PE5$ � � A LICAN79CIIYBUSINESSLICENSENO. <br /> /Z 3 3� /� � � �. . <br /> PLUMBING MECHANICpL <br /> NO. TYPE OF FI%TURE FEE NO. TVPE OF EOUIPMENT FEE <br /> WAiER CLOSET�TOILEp AIR COND.UNITS-4.P. EA. <br /> BA7HTU8 REfRIGERATlO!J UNITS-H.P.EA � <br /> LAVATORV�WASH BASIN� BOILERS-H.P.EA � <br /> SHOWER GAS PIRED AC. UNITS-TONNAGE EA � <br /> KITCl1EN SINK d DISP. FORCED Alq SVSTEMS-�.T.U. M EA. <br /> DISHWASHER WALIHEATERS-B.LU. M � <br /> LAUNORYTRAY UNITHEATERS-B.T.U. N. <br /> CLOTHES WASHER EVAPORATIVECCOLERS <br /> WATER HEATEN CLOTNES DRYERS <br /> _ UHINAI VENIILATION FAN <br /> �RINKING FOUNTAIN RANGE HOOU <br /> FI.00R ORAIN AIR HANDLING UNIT- QF.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DFAINS-RAINLEADER� METAL FIREPLACE d CHIMNEV <br /> SINK SERVICE-BAR,ETC.I WOODSTOVE/FIREPLACE INSERT <br /> _ SUBTOTAL SUBiOTAL S <br /> PEFlMIT S PEflM1T S <br /> � TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �pONiSEfBACN REARSEIBACN SIOESETBACK PLANCN�CKNUMBER P1,IVCMECNFEE <br /> i FfE PECEIPI NO <br /> USE20NE �OIAREA <br /> VACANTSIIC FEES VALUATION FEE <br /> OYES ONO <br /> 17PEOFLONSf. OGLUPPNGYGFOIIP NO.OFOWELLINGUNITS <br /> BUILOING S <br /> 512E Of BL�O NO OF SiOPIES M4%.OCG.LOAO <br /> PL11M91NG <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑N(l <br /> OTHER <br /> PENALTY <br /> AI'PIILAl10N�CC 6Y P�ANSCHECNEDBY �P^' FOpISSUANCEUY � <br /> � � ' / ' � r TOTAL <br /> � ` � � <br /> S <br />