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� <br /> G��„ . APPLICATION F�.R �,�,„, <br /> CONSTRUCTION e <br /> everett PERMIT ,,. <br /> BUILDING DEPARTMENT <br /> 259�8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING �H'SIGN <br /> pqyEq M11L�ODNE55 CIIV 21P PNONE <br /> �/In1C " T �nni:<�c r ._-�Vl��? ��G�� �JL'l.'/ll C7Ll[27'/ <br /> 11HCNrtEGtOR0E510NER M�R�DOPE54 Cirv 21P PHONE <br /> GENER�L GONIR�GIOR MMl ApORE55 GIIV 2iP PNONE UCEHSE• <br /> / 'Ix '_ �4i_' �G.a> � C-'-i >(=✓rT7- .�`''2.- C2'��� -I �..�,�' . Yv. j' . I 1��� � c�I�l <br /> MCCM�HIf,4LOHIP�LIOH M�IL�OOPE95 Clrv IIP PNONC LiCENSE• <br /> OIUMBINOCOHIR�CIOR M11L�ODPE55 Gitt Z�V GI�ONE UCFNSE• <br /> Gl�SS O�WORK <br /> A/NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOI'E/FRPL.INSERT ❑ OUILDING RELOCAiION <br /> vqu���o O�WORrc�coStOfM�t[RUl5vlU5UBOPo <br /> .,,�'�'�'� <br /> oEscaieE woaK <br /> -� c- - - - L )/ � - _ ..�, r712 i�L C.�:� - �. � <br /> use or ewioir�a I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> I -i � - C__t�� '«� PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> IEO�IDEYRiPitONOFpROFENTY�SHOWHBEIOWOHAiI�CNFOURGOPIES� pqOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPE <br /> OF WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED MiERE• <br /> ioi_eioc�—o� IN OR NOT.THE GRANTING OF A PEfiM1T DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR TNE PERFORMANCE OF CONSTRUCTION. <br /> SION�IURE OF COHIRACTOR OR pt1140R12F0 AGENT ORTE <br /> � % <br /> X ,�� ��� � , <br /> /•'/' i c__ G' - <br /> GNOJEGT�D�RESS n ITC�NT5G11YBU51Nf55liC N ENb <br /> PLUMSINO MECNANICAL <br /> NO. TYCE OF FIXTUNE FEE NO. TYPE OF EOUIPMEN7 FEE <br /> WATER CLOSET(TOILEI) AiR CONO. UNITS-HP.EA. <br /> B�TMTUB REFRIGERAiION UNITS-H.F.EA. <br /> LAVATORY�WASH B�SIN� OnILERS-H.P.EA. __ <br /> SHOWEF GAS FIRED A.C.UNITS-TONNAGE EA. <br /> KITCHEN SINN 6 DISP. FORCED AIR SYSTEMS-B.T.U. M EA. <br /> OISHWASHE(7 WALL HEATERS-B.T.U. M _ <br /> I.�UNORY TR�V UNIt HEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS _ <br /> W�tER HE�TER CLOTHESORYERS _ <br /> URINAL VENTILAiION fAN _ <br /> OFINKINO FOUNTAIN HANGE HO00 <br /> fLOOR�RAIN AIR HANDLIN6 UNIt- CF.M. __ _ <br /> VIICUUM BRE�KERS STOVE _ <br /> ROOF DRAINS-RAINLEAOERS METAI FIREPLRLE 8 CHIMNEY <br /> SINK SERVICE-BAP,ETC. WOODSTOVE/FIREPLACE INSERT ___ <br /> SUBTOTAL SUBTOtAL _ ! _ <br /> PERMIT f PEPMIT _ ! __ <br /> T0T11L FEE ! TOTAL FEE 3 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> �RONISEIB�CN RE�RSEIB�GR SIGESEIOACN PLANGNEGNNUMB[N �L�NCI�EChfCE <br /> IEE nEC[�PiNO <br /> USEZONE �OLAPE� y���NT51iE V�LU�iION FEE <br /> pYES ONO FEE4 <br /> TYPEOlCONSI. OCCUPANCYGROUP NO.OFDWELLIN6UNIT4 <br /> BUILOIN6 f <br /> $RE O!BLDO. MO Of SiORlE9 MA%.00C LOeD — <br /> PLVMBING <br /> MECHANICAI <br /> FIRE SPPINKlERS REOUIRCO ❑YES ❑NO <br /> O1HER <br /> PENALTY <br /> APPUC�l10N�CClY FL�NSCNECNFORY �PP0.fOR139U�N .� — <br /> L��� TOT�L <br /> � ^ <br /> //�� � <br /> , �� 'l�>�jn <br />