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rim <br />APPLICATION `S OR <br />CITY OF "AMR CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ® SIGN <br />PHONE -- <br />_0 <br />U <br />0 <br />0 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />6T <br />IL <br />PHONE <br />-,ENE RAL CONTRACTOR <br />y-FSP /-4Q1- (71t��q�S <br />MAIL ADDRESS <br />ps+. P,...i( 19C�1� <br />'SL'AT'T'1�._ ��lOi <br />ZIP <br />PHONE <br />I-sup-stiz-�esxr�-8�+31(1 <br />LICENSE IF <br />MECHANICAL CONTRACTOR <br />MAIL nDDRE SS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />PLUMPING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PNCNE <br />LICENSER <br />".l A58 OF WOR.. <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEIYT ❑ BUILDING RELOCATION <br />rt UATION OF WORK ICOST Or MATERIALS PLUS LABOR) <br />'R SCR)BF WOPk <br />-.I_ Inl_.InT GI .z ..✓ cl/.l C_..rAi RI a./ f�FRI N •F�Ta� AVAAc <br />115E Of BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNINGTHIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF' <br />ANY OTHER S1 ATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 1--7 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH f OUR COPIESI <br />LOT_BLOCA—OF <br />PROJECT ADDRESS <br />lR I L <br />APPLICANT'S tAY BUSMP SSLICENSF NO <br />.7c.1�8 <br />PLUMBING __ <br />MECHANICAL_- <br />TYPE Of EOUIPMENT _ _ FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY WASH BASIN <br />BOILERS-H P. EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS-8 T U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.TU M <br />LAUNDRY TRAY <br />UNIT HEATERS-81 U M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGF HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM____,- _ <br />STOVE <br />METAL FIREPLACE S CHIMNEY <br />_ <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />SINK SERVICE -BAR, ETC <br />WOODSTOVEIFIREPLACE INSERT <br />SUBTOTAL <br />_SUBTOTAL _ _-S <br />_—PERM - IT _ _ _ f <br />_-_ TOTAFEE1 <br />_ <br />-- <br />-PERMIT ! <br />_ <br />_ <br />TOTAL FEE f <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'PONT SFTOACK RE.ARBE TBACK SIDE SETBACK PLAN C HE CK NUMBF R PLAN GHFCk FEE <br />U5F 'ONE ILUT AREA I VACANT SITE <br />LIVES ONO <br />TYPE Of COAST I OCCUPANCY GROUP I NO OF OWEL LING UNITS <br />SIZE Of BLDG I NO. OF STORIES I MAX OCC <br />FIRE SPRINKLERS REOWPED ❑ YES ❑ NO <br />PLANS CHECkEO BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEES <br />FEE RECEIPT NO <br />VAWATION I FEE <br />S <br />-11 <br />.t I <br />dl <br />