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A.jPLICATION FOR-' <br />!Y <br />OF <br />OF°'"" <br />CONSTRUCTION <br />0 <br />CITY <br />cm <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259.8745 <br />❑ DEMOLITION <br />❑ COMBINATION yQ BUILDING ❑ MECHANICAL <br />O PLUMBING <br />❑ SIGN <br />OWIID <br />MAR ADDRESS CITY 21P <br />7S^�^ooNE59 �G['tL V�AZ'nC L`L•'e�.fG JT ��ztSi/V .i <br />P14ONE <br />3o C � yn Yf <br />^RLNI�IUR DE51�� y� <br />Vie%-x4c nrtw-�- <br />CNY ZIP <br />PHONE <br />L'JENSE <br />GENERAL CONTRACTOR <br />MMI ADDRESS <br />�C S/fr Y'nJ 45�sIP <br />E•c:cJ�r� <br />°/ <br />t!^C'C ciC' U(ln <br />57-C'c,_ <br />s C7r- //�i Aa.. Ac <br />CITY ZIP <br />P O lE <br />O <br />CEF6C <br />LCENSE <br />MECRANIF,4 CONIRACIOq <br />MAIL AOOBE95 <br />P W MBINR CONIPALTOR <br />MAIL ADDRE99 CITY TIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT 0 BUILDING RELOCATION <br />VALUAIION OF WORK ICOSI OI UAl1.lUAL9 PLUS LADONI <br />.1lGiQ. K}, <br />DESCRIBE WORK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO, <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPLICANTS CIIY BUSINESS LICENSE NO. <br />PROJECT ADDRESS <br />AIECHANICAL <br />PLUMBING <br />-- <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTUREWATER <br />AIR <br />UNITS-N.T EAREFRIGERATION <br />CLOSET (TOILETI <br />RIGERCOND. <br />UNITS-N.P. E0. <br />BAIHTLIO___LAVATORY <br />BOILERS-H.P. EA. <br />(WASH BASINI <br />qFENO. <br />GAS FIRED AC. UNITS -TONNAGE EA <br />SHOWERKITCHEN <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />SINK 8 DISP. <br />HEATERS-B.T.U. M <br />DISHWASHERWALL <br />UNIT HEATERS-B.T.U. M <br />_ <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />_ <br />_ <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE 9 CHIMNEY <br />_ <br />ROOF DRAINS-RAINLEADERS <br />WOODSTOVE/FIREPLACE INSERT <br />SINKSERVICE-BAR ETCI <br />— <br />SUB TOTAL IT <br />SUBTOTAL — <br />PERMIT IT <br />_ <br />PEIIMIT f <br />TOTAL FEE f <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNtL <br />L_ <br />7. X' <br />S" - <br />LOT AREA <br />VACANT SILE <br />GYES�NO <br />NjI <br />OI:CUPRICY GOOHP <br />NO OF DWELLING <br />lG <br />NO OF STORIES <br />MAX OCC LOAD <br />;AIIONACC BY PIAIISCIIECKEBBY IAPPR FORISSUANCI <br />'LANCHE nNUmndn _l — <br />L� 1�.\ `� <br />('�lj,2 1 FEE /�I I .. '� RECEIPT <br />FEES I VALUATION <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />Y "l 1 <br />