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I <br />the FrQL.R ASTUTNR <br />Cin Or APPLICATION <br />r.rrrtl <br />everett PERMIT <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />2595745 ❑ COMBINATION ® BUILDING ® MECHANICAL 91 PLUMBING ❑ SI,9N <br />OWNER MAIL ACORESS C,.ITY ZIP PHONE _. <br />�r�.A TF I --,-,-I O11/-\I) C_ .IAY.n.le%AII J . .. .>,o__ - <br />u / <br />ONER MAN1AGGRESS Cltt <br />ARGIBITCt OROEBIZIP PHONE <br />�� 1� r�lL — _ .__ --- -- --- ,. <br />O NrHALCCNIRACTOR MAIL ADCRESS dtt ZIP PHONE IICEN9FA <br />_' ��=-- <br />MECRANICAL GONTRAClCq MqL /.ODRESr CRY ZIP PHONE LK)TNSEA <br />LIUMRINO,f�.gINIRA CTOI1 PUL ADORE88 CITY ZIP FHONE IICCNSE r <br />FlRL� 7n�� ��tiS7c. <br />CI A990r WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPI INSERT Cl GUILOtNG RELOCATION <br />VALUA UUN OF WORK [COST OF MAIERMLB PLUS LABOR) —' <br />40 coo <br />B^.r or ER. nINo <br />1, rj- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAMETOBE TRUEANDCORPECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING T HIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFAPERMIT DOES NOT PRESUMETO <br />GIVE TO VIOLATE�i1iJJ R CANCEL THE PROVISIONS Ole <br />ANYOTH R STIATE TY OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />F� 1 IJ <br />TUE <br />SIGNATURE O)F CONTRAC�Bj�AUIHORI2EDNf DATE <br />LEGAL DEscRIPunN of PaOPEnn.0"GAIN BELOW ORATTACH FWRCOPIES) <br />..r,ocl�oF_IL�YJLC.IUV� <br />1%AOLk 1% `�1L:-L� <br />PROJECT ANUNES9 <br />8%8 84T,{ 6T. S EA <br />APPLICANrS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />00 <br />AIR COND. UNITS-H.P. EA <br />I <br />BATHTUD <br />_ <br />OO <br />REFRIGERATION UNITS-H P. EA. <br />LAVATORY WASH BASIN)OD <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AG UNITS -TONNAGE EA_ <br />KITCHEN SINK & DISP. <br />UV <br />FORCED AIR SYSTEMS-B.T.U. M EAJ <br />z90 <br />I <br />DISHWASHER <br />00 <br />WALL HEATERS-ST.U. M <br />I <br />LAUNDRYTRAY <br />UNIT HEATERS -BTU. M <br />I <br />CLOTHES WASHER _ <br />_ <br />O(7 <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />00 <br />I <br />_ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKINU FOUNTAIN <br />RANGE HOOD <br />Sat) <br />— <br />FLOOR DRAIN <br />AIR HANDLING UN - C.F.M. <br />_VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLFADERS _ <br />METAL FIREPLACE& CHIMNEY <br />SINK SERVICE-DAR ETC.1 <br />WOODSTOVEIFIREPLACE INSERT <br />SUBTOTAL <br />t& <br />V <br />/L,' <br />_ <br />SUBTOTAL & <br />PERMIT & <br />PERMIT & <br />_ <br />TOTAL FEE & <br />_� <br />TOTAL FEE & <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />;t IPACK <br />REAMsrr(BACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />iQw <br />7,19r` <br />c(A� <br />Tyr /� L <br />OJ 7 <br />FEE <br />RECEIPT NO <br />LOTAREA <br />VACANT SITE <br />FEEB <br />VALUATION <br />FEE <br />— <br />C"n ONO <br />CONRT <br />CCCy�e� NCYOROUP <br />NO OF OWELLINU UNITS <br />I� ^ 03 <br />f <br />BUILDING <br />EprQ A� <br />_ - <br />e4i <br />' <br />BI DU <br />NO Jr STORIES <br />MAX OGC TOAD <br />Aer R, <br />APPA FORISSUAN <br />GAG <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />9O <br />)0 <br />