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I <br />r <br />m <br />APPLICATION <br />FOn <br />the r°r..D <br />cveren <br />CITY o <br />CITY u f <br />CONSTRUCTION <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 />4 SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />0731E CIL)+xCOR ADS/ <br />9/<Ti 2 /2/ <br />�b'3 Sti <br />�7 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />r <br />C� f�_ qg l4 171 EKr. l <br />, /vU d EAlkL A \ 15c, L/ v� LL4m <br />GENERAL LONiRAC10 <br />MAILADDRESS CIFY zip <br />PHONE ] -I <br />LICENSE• <br />L4,KENcE (lf�lF <br />�0.1TIk 271-3 !"vC'.(N! P>� �17yGz <br />i(5 c! <br />/.r1UD�0 <br />MECHANICAL CONTRACTOR <br />MAIL AOpRE S CITY LIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAILADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />fa NEW ❑ ADDITION ❑ ALTERATIUN ❑ REPAIR ❑ LGMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />/ALUAT ION OF WORK (COST OF MATERIALS P.US LABOR) <br />d,.�5 00 <br />'DESCRIBE WORK <br />IIR:IA✓.'n ' <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE 7RUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF 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. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />'T��I <br />LEGAL DESCRIPTION OFPROPERTYISHOWN BELOW OR ATTACH FOURCORES) <br />GT_ G (—eLoc - uF "j) h <br />PROJECTADDREss <br />APPLICANTSCITI'BNESS LICENSE NU <br />IU <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 />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& DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <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 11000 <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE -BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL E <br />PERMIT f <br />PERMIT E <br />TOTALFEE & <br />TOTALFEE E <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIDE SETBACK <br />/✓d <br />use ZONE I LOT ARE ^ I VACANT SITE <br />DYES AND <br />or BLDG <br />#14 I NO. <br />JE'c <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE� <br />FEES VALUATION <br />E <br />FEE <br />