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APPLICATION FOR <br />Y F H <br />the ErugFwn <br />OF <br />CONSTRUCTIONClrr <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />IR SIGN <br />OWNER <br />MAIL ADDRESS CTry <br />PHONE <br />950 { 14A�ES� EveaErr <br />ARCHITECTOR DESIGNER <br />MAILADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE ru-0a'D1, Ilgs <br />T-Poo-51.�.-asS� <br />-TLJBE,ARrD15 <br />A/S Po,3o,c.G19t?13 �EC*4 981cq <br />IICENSE <br />iAEGHAenC,�L CONTRACTOR <br />MAIL ADOR SS CI ZIP <br />PHONE <br />PLUMPING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />"111 NEWV ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK r-... I.I c II - 0. -� II)c-Yl•., , \ 1= G. T-YL <br />Inl k-- -zoltn1.. T ...r.i <br />7 _----.-z=—^.-.. <br />USE OF BUILDING <br />I H REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LACIS ANn nRPINANC're rn,IFRNINTT TH19 Tv PF <br />LEGAL DESCRIPTION OF PPOPr PTY(SHOWN BELOW OR A TTACH FOUR COPIES <br />Lor_RLocI�_ol -- <br />IN OH NOT. IHEGHANIINGOFAt'EHMIIUUESNOT t J <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />--- <br />SIGNATURF Or CONTRA B AI;THORIZrD AGENT OATF <br />X__ ;--/ >, 8 c,7- <br />PROJCCL ADORr.55 <br />APPLICANTS CITY BUSINESS LICENSE NO <br />9504 14Tiff Ave .s E�- <br />SIAN <br />PLUMBING _ <br />_MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE _ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA <br />_ <br />_ <br />BATHTUB <br />_ <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />LAVATORY GNASH BASIN) <br />BOILERS-H.P. EA <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />SHOWER <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-G.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />._ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />-_� <br />SUB TOTAL <br />_ SUB TOTAL s <br />PERMIT S <br />—PERMIT <br />TOTAL FEE S <br />., <br />-- -- TOTAL FEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />