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U� EW�prNn <br />CITY Of <br />everett <br />BUILDING DEPARTMENT <br />259•8745 <br />:.PPLICATION FO�. <br />CONSTRUCTION <br />PFRMIT <br />TO BE COMPLETED IN iNK- PLEASE PRINT <br />cveretl <br />e <br />❑ DEMOLITI*JN ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />UWNE1i �� MAIL�OORESS CITV 2�P PIIONE <br />�us�s ll_.�►�n�sc���s�o�vS il3/ �'u�'iz��zE�� �v�� £�c. �s�-ciz9/ <br />Clrv ZIP <br />GENERALLONIRALiOR MAIUOONE55 C11V ZIP PMO��E LIGENSE• <br />MECHANIf,�LGONIN�CIOA MAILROORE55 Cltt ZIP PNONE IILENSC� <br />�uTo �u,,�ca. y�2�-c�ie�E�r+�c sr�7�o EU�• Ixl�j. 9�.?�/1252-Z233 <br />PLUMBINOCOHtMCtOR M�IL��OFE55 CIiY ZIP PIIONE .ICENSE• <br />F�.� rvc ��i 3 �.s <br />CL�SSOF WORR <br />❑ NEW ❑ ADDITION ❑ AITERA710N ❑ REPAIF ❑ DE�� )LITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILOING RELOCA710N <br />ID�N�COSiO! <br />eo <br />use ov auamNc <br />im— <br />TVPE OF <br />WATER CLOSE7 �TOILE71 <br />BATHTUB <br />LAVATORVIWASH BASIN�, <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHEii <br />WATER HEATER <br />URINAL <br />DRINKiNO FOUNTAIN <br />FLOOP. ORAIN <br />fYPE OF CONSL. <br />FIRE SP' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />N 1/LS PLICA'fION AND KhOW THE SAMETO BE TRl1E AND CORRECT. ALL <br />ORAiT�GHFOURCOPIE51 PROVISIONSOFLAWSANDORUINANCESGOVERNINGTHISTYPE <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 />A(JY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON!RACTOp OR AUTHORIZEO AGENT OATE <br />X—�'�'�a � �2� �� <br />�PPLI R iSCITV8U51NE55LICEN5EN0 <br />IECHANICAL <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNITS—H.P. EA. <br />REFRIGERATION UNITS—H.P. EA. <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNIiS—TONNAGE E0. <br />FORCED AIR SVSTEM$—B.T.U. M EA. <br />WALL HEATERS—B.T.U. !A <br />11NITHEAiERS—B.T.U. M <br />THIS PORTION TO BE COM�LFTED BY BUILDING DEPT. PERSONNEL <br />RCCBY �PVNSCMEGKEOBY <br />SIOE SEi6RGK <br />VRCFNi SIiE <br />OYES ONO <br />NOAF OWELLING UNITS <br />MR%.OLC. LOaD <br />AVP!1. FOR ISSUr1NCE BY <br />GHELN NUMGER � AIAN CMECK fEE <br />FEE I �ECEIPT NO <br />BUILDING <br />PLUM9ING <br />MECHANICAL <br />OTHER <br />PENALiY <br />TOTAL <br />FEES � �A�UATION � FEE <br />E <br />