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Everett <br />-APPLICATION Fait <br />theEYer9Taen .IT CONSTRUCTION <br />:ITY Of <br />everett PERMIT ki <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />IUILDING DEPT. �/ <br />159.8745 El COMBINATION q BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ILCHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />Z'P <br />rn°nc <br />a q7rL q <br />LUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />.LASS OF WOR <br />Cl NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />ALIIATION OF WORK ( QST OF MATERIALS PLUS LABOR) <br />,#�� Ann O� <br />Ar scnITEWORK <br />19E OF B_ Ir IIDINO <br />1 EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <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 Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />OR AUTHORIZED AGENT DATE <br />SIGNATURE OF CONTRFed-��L�t <br />x ��1(' <br />EG'ALjDESCRIPTIONOFPROPERTY[SHOWNBELOWOnATTACHFOURCOPIES) <br />OT �/ BLOCK �OF <br />A, /. •' <br />.t.�� <br />Ki✓rr <br />'RpJECT�DRES9 � / ��� ��� r <br />°LUMBING <br />APPLICANTS CITY BU91NE95lICE N0. ' <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 />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY(WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER A <br />1 EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOJO <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE S CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT 9 <br />TOTAL FEE 9 <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />O <br />O <br />ISE ZONE <br />LOTAFIEA <br />YPEOFFCONST. <br />OCCUPANCYGROUP <br />•3-2_ <br />EVACANTSITE <br />WELLING UNITS <br />0UUILUINU <br />RZE OF BLDG. <br />NO. OF STORIES <br />C. LORD <br />PLUMBING <br />LIRE SPRI14KLERS REQUIRED ❑ YES NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />TPPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />6 / v nwun •?-y <br />FEES VALUATION FEE <br />:12, DcX�D IT; 9,Z "U <br />