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r <br />L <br />the EIIIrPEAIR APPLICATION F G A IYI,I„ <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING Cl SIGN <br />GINNER MAIL ADDRESS 1 GIIY bP PHONE <br />eve � nuSSen 31 �ee h `sl,'t EL""'If 3q?-g(slo <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY lip PHONE <br />GENERAL CONTRACTOR MAIL ADORESB CITY ZIP PHONE UCENS: A <br />C1. 1 _ IT AIII— .I_ <br />MECHANICAL CONTRACTOR V MAR ADUREbS L.I/ ZIP PHONE LCENSIL A <br />PLUMBINGCONTeACTOR MAIL ADDRESS C.M1 Pp PHONE LICENSE A <br />CLASS OF WORK <br />J $ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />�AI UAIIIllNN OF WORK ICOST OI MAILRIALS PIU5IAIIOHI <br />1] g ObC1•UD <br />RL VIP�RL WGP�II <br />'1 u <br />iacie- <br />USE OF BUIL DING <br />Ic C''G I J E " Gi <br />C <br />I EREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAF- <br />PL ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT :.Ll <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 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 TO VIOLATE OR CANCEL THE PROVISIONS Of <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. p/L� <br />M SIGNATURE OF CONYCTTOORR 00 AUTHURIZED AGENT DATE G / 4 <br />X VL <br />- <br />IIU IDIMNIPFIONOr PHOPLHIII[NONbEI(IWORAIIAGI 1 OUR CDIESI <br />a I ILA' �1 �11�, 1,,, , <br />Lor -� • bra:IL_ur 11 �_ ++fn.-T <br />to S nrr •� E'PP..r. ly,l <br />L <br />PROJECTADORL55 <br />3 �f t <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />_ NO. _ TYPE OF FIXTURE _ <br />WATER CLOSET I TOIL E <br />_ _ fE[ <br />_ <br />MECHANICAL <br />N_O. TYPE OF EOUIPME_N_T_ <br />_ <br />_ <br />AIR COND UNITS-H P. EA <br />__FEE <br />_ <br />_ <br />BATI/_TUB <br />REFRIGERATION UNITS -HP EA <br />EAVA7ORY (WASH OAS <br />_ <br />BOILERS -HP EA <br />_ <br />SHOWER <br />_ <br />GAS FIRED AC UNITS -TONNAGE EA <br />_ <br />_ <br />KITCHEN SINK{ OISP <br />_ <br />FORCED AIR SYSTEMS-B T U M EA <br />_ <br />DISHWASHER <br />WALL HEATERS -BTU M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS-0 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER v <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING NIT- C F M <br />VACUUM_ BREAKERS <br />STOVE <br />_ <br />ROOF DRAIEJ5 -RAINI FADERS <br />SINK OA HVE(A UAII I ICI_ <br />SUB iOTAL <br />PERMIT S <br />TOTAL FEE S <br />_._. <br />_ <br />METAL FIREPLACE A CHIMNEY <br />_ <br />WOOOSTOVE/FIREPLACE INSERT__ <br />SUB TOTAL B <br />PERMIT [ <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL. <br />NEAR SETBACK I BIDE [EIBAGK I PLAN CHECK ILUNIER I PLAN CHECK <br />BE ZONE <br />C- 7j <br />LOIAREA <br />VACANTsSIT <br />nYt6 1�O <br />/[U <br />rPE OF CORST <br />Y� N <br />OCCUPANCY GROUP <br />M <br />NO OF DWELLING UNIrB <br />BUILDING <br />4E OF bI DO <br />064 5-F <br />NU OI STORIES <br />MAR OCC LOAD <br />-•--- <br />PLUMBING <br />,/ <br />IRE SPRINKLERS REQUIRED DYES U40 <br />MECHANICAL --_- <br />OTHER <br />_ <br />PENALTY <br />APLICATION ACC BY <br />c__ <br />PIANSCHECKEUBY <br />14ton <br />APEAR FOR ISSUANCE BY <br />Z .G. <br />TOTAL <br />[ <br />III <br />