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ro <br />APPLICATION FGA <br />CITY OF ITrE"'°'"D CONSTRUCTION ki <br />C <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER 51 MAIL ADDRESS CITYZIP PHONE <br />LAu e: I/R/{(21E< O ral -r:c7t wy �E�Ert— <br />.........7 f.I TY nP PHONE <br />r RAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />IIP <br />PHONF IICt NSE• <br />C�RL1 A,GbIII 'X,NC <br />�0 80( <br />5p) LYNlyu,'op <br />9g�`Yl. <br />-71-" 35- B�Yr/c.3�/�c <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />CLASS OF WORK <br />0-NEW ❑ ADDITION ❑ <br />ALTERATION ❑ <br />REPAIR ❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL TION OF WORKICOSTOF MATERIALS PLUS LABORI <br />l99s� <br />DESCRIBE WORK <br />I <br />-r.1 .. . Alb.. n-A..I <br />�A *27 AY IC-1 <br />-I� �r�,i� <br />%- / A. IiX.T_I ITn // IIA.f IAiAw-v <br />.t�/� <br />��/.A.) 17/% k4t'z mu h-rc <br />L <br />_Ise of ewLOINc <br />D R C <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATIONA14D KNOWTHE SAMETOBE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WuRK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />CIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU /FF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X Wi\ I Y�• 1 1 00 <br />_FGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK _OF <br />PROJECT ADDRESS <br />2/o ilgz N W <br />PLUMBING <br />APPLICAkPS CITY BUSINESS LICENS NO. <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF FIXTURE <br />FEE <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS— I.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 />LAUNDRY TRAY <br />UNIT HEATERS—B.T U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL _ f <br />_ <br />PERMIT f <br />PERMIT f <br />_ <br />TOTALFEE f <br />TOTAL FEE ______. f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />i■ <br />.d ■ <br />