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IA. EY.rgmn . ,PPLICATION FO►=' <br />DITYOF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />JWNER, MAIL ADDRESS CITY 21P <br />❑ PLUMBING <br />VLrvLNwL I.VNIHw{i1VN <br />'C�ZRy <br />iL nuull[JJ <br />Box 52by <br />I'll r <br />�yiUAlwcbo `?¢� qb <br />I'IIVrvI, <br />776-YB5- <br />LILLNbt <br />&9P-V N4,,7Y74 <br />M HRNICALDONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CON TRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />G__L..A,,+ASS OF WORK <br />,, <br />All -NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPLANSERT Cl UUILDING RELOCATION <br />i/ O <br />TAJC-Rl1 CGSTDMF/LS 5/< rtLUAiiA.111Trrb A-16u 0)J gu/i Omj-r— <br />USE OF BUILDING <br />nF� C <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO SE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCF OF CONSTRUCTION. <br />SIGNATU E / CONTRACTOR OR ALIT RIZED AGENT +DATE QQ/ <br />LEGAL DESCR PITON OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LDT_SLOCK—Or <br />PROJECT ADDRESS�T <br />APPLICA CITY BUSINESS LI ENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA, <br />IAVATORY(WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA. <br />KITCHEN SINK & DISR <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. Ni <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAIN S—RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK SERVICE —BAR. ETC, <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTALFEE S <br />TP:o— PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />!ONE LOTAREA VACANT SITE <br />FEES VALUATIO'1 FEE <br />OYES ONO <br />OF CONST, OCCUPANCY GROUP NO. OF DWELLING UNITS <br />APPLICATIO1 <br />4 ACC <br />BY <br />. <br />PLANS CHECKED BY <br />BY <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />�y <br />