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It <br />PPLICATION FOb. <br />CIT), Of The °I"D CONSTRUCTION <br />everett PERMIT P+lrlN <br />8UILDI14G DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL 0 PLUMBING 0 SIGN <br />JWIUR MAIL ADDRLS$ CITY ZIP PHONE <br />�� �'(reoX6-X2 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SIP PHONE <br />LICENSE <br />.5,x,.4 <br />,! aofA <br />/ Xu f 1 <br />MTCNINKAI CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP IT <br />PIVH <br />lx:ENSE <br />PLUMBINII CONTRACTOR <br />MAIL ADDRESS <br />City <br />!I1• PHONE <br />LICENSE• <br />, INEWV^-❑ ADDITION (3 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />1 UA LION OF WORN (COSI OF MATERIALS PLUS LABOR) <br />�. on Q) <br />l,Aj ..rimvl .%1'ANIA 7Au.YYl1, J�//.T_/�� kPL/', /-0/ A) <br />USE Or nun DING <br />JI L+:�.I 1 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TOBETRUE AND CORRECT .ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OFCONT�REACTOR OR AUTHORIZED AGENT DATE <br />APPLICANT'S CITBUSINESS L ICENSE NO <br />LEG+L nEI.cRi )ION OE PRUPERIYISI LTYN BELOW OR ATTACH FOUR COPIES <br />/�/ <br />C L <br />PR.IJECT ADDNESS <br />721 ?DW. P1, SA EL <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />'2_ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />/D <br />_ <br />AIR COND. UNITS-H.P EA <br />q- <br />BATHTUB <br />O <br />REFRIGERATION UNITS-H P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS-H. P. EA. <br />SHOWER <br />—�E <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK E DISP. <br />p <br />_ <br />FORCED AIR SYSTEMS-0 T.0 M EA <br />/ <br />0)SHWASHER <br />WALL HEATERS-0 T.0 M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />-WillifeATICEATER <br />URINAL <br />CLOTHES DRYERS'W_ <br />VENTILATION FAN <br />- <br />DRINKING FOUNTAIN <br />RANGE IIDOO <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M__- <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE E CHIMNEY <br />SINK LSERVICE-BAR ETC I <br />WO�ODSSTTOOVVE/FIR�EjPL�ACE INSERT <br />W=tie—BCsa !r'"-'-• - <br />-1 <br />_ <br />EUB TOTAL <br />SUB TOTAL <br />PERMIT E <br />PERMIT L <br />TOTALFEE S <br />TOTAL FEE • <br />��` <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IRGNISEIBACnK REARSETBACK SIDE BETIM21i PLAN CHECK NUMBER 11 CHECK FEE <br />K b f�LG G C I+• / Or la's )I c, ) RECEIPT NO <br />USE 1L'NE LOTAREA VACANT SITE 17 �J J' <br />72.111 OYES ONO ^. �5lU VALUATION FEB --1 i—; l <br />Dino <br />r`1f1 n <br />No or STORIES <br />MAX otx LOAD <br />BUILDING <br />PLUMBING <br />PRINKLERS REQUIRED DYES ONO <br />MECHANICAL <br />OTHER <br />PENALTY <br />l)ION <br />ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />LTOTAL <br />