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r%PPLICATION FOL. <br />C/TEN"° <br />Ortv OrF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT <br />269.8746 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAILADDRESS CIT, IMP <br />PIIONI <br />GR �� cuStDwi <br />6•ILMr, ttjc _ <br />-- <br />ARCHITECT OR DESIGNER <br />K-en LViRsdJ <br />MAIL ADDRESS CH, SIP <br />mmrntyk LJIUTAC/e <br />M.ONL <br />33Y•Lw6"E6rt <br />GENERAL CONTRACTOR A ML ADDRESS 1 ..CI[Yn, �#Lt 1.111E y <br />I /S(o1M b4o►11,9 iAJ c Lam% zem. E � Va INF1 l <br />PHONE <br />353-4SW <br />LICENSE IF <br />CRONI I — <br />C <br />MECHANICAL CONTRACTOn <br />MAIL AOJRESS CITY 11P <br />PHONE <br />21A11.TM5rff <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY SIP PHONF LICENSE IF <br />CLASS OF WORK <br />$!� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL UATION OF WORK (COST Of MATERIALS PLUS LABOR <br />&,5j &%jc <br />DESCRIBE WORK y, <br />USE Of BUILDING .}-. �jY <br />5/A44U /�7N ,Lle I[.T <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNnVV THE SAME TO BE TRUE AND CORRECT. ALL <br />F'nl''�"•.,I• .. •,nrn•L;..I••r•: r,I CT+I!t'I(` TII"•'•YE <br />IF,, I'll, PT1GrT^•.,an.wN PTLOW 00ATIECNTU.IR CUPPF.s1 <br />4 fir.ItltLG_ <br />;; <br />GIVE AU I I E ON <br />ANYOTHERSIAILUHI -.� LAW REGULATING CON5I HUL, I IL,, <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIUNARJRE OF CONTRACTOR OR AUIIIO n O AGENT DATE <br />XcUy Uv 9 /2c& <br />PROJECT ADDRESS <br />BUSINESS J <br />APPOEAN�IUENSE N <br />M/7 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSF.TJTOILED <br />AIR COND UNITS-M.P. EA <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P_EA <br />_ <br />LAVATORY WASH BASIM <br />BOILERS-H.P. EA <br />SHOWER <br />OAS FIRED A C. UNITS -TONNAGE EA <br />. <br />KITCHEN SINK A DISP. <br />_ <br />__ <br />FORCED AIR SYSTEMS-8 T.U. IA LA <br />1 <br />DISHWASHER <br />WALL HEATERS-8 T.U. M <br />LAUNDRYTRAY <br />_ <br />UNIT HEATERS-B.T.U. M <br />1 <br />CLOTHES WASHER <br />EVAPOR411VE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADFRS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE-!t.R CL_ <br />WOOOSTOVEIFIREPLACE INSERT <br />BUD TOTAL <br />SUBTOTAL A <br />O� <br />PERMIT A <br />PERMIT f <br />TOTAL FEE • <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />SIDE BEIMKLK <br />2ipf'Y I <br />LaP <br />'REA <br />VACANT SITE <br />IBM ONO <br />UNITS <br />SX.—M Q 3 M l <br />( Of BLDG y NO OF 510RIES MAl OCC <br />4 <br />CATIONACC BY I PLANS CHECKED BY IAPPR FOR ISSUi <br />10 6 -c <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />r- <br />• IPECEIPTNO <br />EEE <br />