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,-.PPLICATION FO1� ���fe„ <br /> ��r�F-�-•" CONSTRUCTION e <br /> everett PERMIT <br /> TO BE COMPLETED IN BL:.CK INK— PLEASE PRINT <br /> BUILDING DEPT. ,y� <br /> 259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING Id SIGN <br /> OWNE � M�ILAODRESS Cltt ZIP PMONE <br /> ,�a S ��� QD� ��:SYilu�2A.vT �,�E�� ��Za 3 <br /> �fld11TECTOROESIGNEP MRILAOORE55 CITY ZIP PMONE <br /> OENENALGONTR�CTUP MNL�DONESS CIiY ZIP PMONE LICENSE• <br /> �/rS� Sr�✓Sr.e✓r°� � oox ��2� 7 �✓c2� 9�rzv3 ,3.39-zGs�tl c�ryssr�s8ok <br /> MECM�NIC�Lf,ONTPACTOq MRILAOOflESS CITY ZIP PMONE UCENSEI <br /> PWMBINOGONTPACTOR MAILA�DRESS CI7Y 21P PMOHE IILENSE� <br /> CUSS OF WORK <br /> �I NEW ❑ ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOI.ITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALU�TI OF W/ORN�W 5T OF MqTERIhLS P W 5 LABON� <br /> p�lO Q�� UQ _ <br /> DES RIpE WORN <br /> z',t/JT .L .:7 TCCt!f/i.UifTc � S/r.JS � C�/�A�UA/ELUM�E LJ�4LL SI�i1� � o? E.VT4�NPE Sir S <br /> lISE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI5�P- <br /> �S7" U2�4 PL�CATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEGRLDESCflIPfIONOFPPOPEfliY�SNOWNGELOW AT/ACHFOl1PLOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> �or—e�oc�or IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CAMCEL THE PROVISIONS OK <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF TRACTOfl Ofl AUTHOPIZED AGENT DATE <br /> X ��P � �z.-e_ //�-��� <br /> PflOJELT�DDRE55 �PPLiGRNTS CITY B1151NE55 LICENSE NO. <br /> /o aor ,�u�2r�c��'� wy <d�,e�,%. ,3 /33 <br /> PLUMBING MECHANICAL <br /> NO. hPE OF FIXTUNE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH CIOSGT�TOILEI) ' AIR COND. UNITS—H.P.EA. <br /> BAiHTUB REFflIGERATION UNITS—H.P.EA. <br /> LAVATORV�WASH BASIN� BOIL[RS—H.P.EA. <br /> S110WER GAS FIRED 0.�.UfJ1T5—TONNAGE EA <br /> KITCHEN SINK 8 OISP. FORCED i�iR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALLHEATEFS—B.T.U. M <br /> LAUNDRVTRAY UNITHEATERS—B.7.U. M <br /> CLOTHES Wh�HER EVAPOf1ATIVE COOLERS <br /> WA1ER HEATER CLGTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HO00 _ <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—flAINLEADERS METAL FlREPLACE 8 CHIMNEV <br /> SINKISE�iVICE—BAR,ETC. WOODSTOVE/FIflEFLACE INSERT <br /> SUBTOTAL SUBTOTAL i <br /> PEPM17 S PEflM1T S <br /> TOTALFEE S _ TOTALFEE f <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONTSE79aCK REARSETBRCK SIUESETOACN FLANCNECHNl1MBER PUNCMEGNFEE <br /> FEE NEGEIP�NO. <br /> ❑SE20NE LLTRRE� VACRNTSITE <br /> FEES VALURTION FEE <br /> OYES �NO <br /> lYPEOFCONST. OCCUPANCYGPOUP NO.OFUWELU.NGUNIT3 __ <br /> 6UILDING S <br /> SIZEOFBL�C NO.OFSTOHIES MA%.00C.LOAD <br /> PLUMBING <br /> MECHANICFL <br /> FIRE SPRINKLERS REOl11FiED ❑YES O NO <br /> OTNER <br /> PENALTY <br /> APPIICATIONACC.BY PLPNSGNECKE�BY 1VPh.FOfl155lIPNCEBY <br /> i� � „ TOTAL <br /> %/ %/ <br /> /u.// <br />