Laserfiche WebLink
I <br />r <br />L. <br />i <br />S fM EwFpn�n <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259.8745 <br />,PPLICATION F6�lw' L61 <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />ARCHITECT OR DESIGNER <br />1 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CIF! <br />ZIP <br />PHONE LICENSE <br />(SPRY /VFon► <br />TNc. �o. B,,x <br />5P69 t*#JQD 0 <br />9Ba4i <br />774-kW_ Garay N AE17I <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 />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BIIII n)Nr, RFI nrATIFTH <br />2 uSEo �GA 5 -► / (15E0 s J'044 4,4770 <br />DESCRIBE WORK <br />�N5r4LL ` d 3� S` OF !Zo -c AG-RLL I TL=21OR Zau <br />USE OF BUILDING <br />/�J <br />C OMMOIAZ.- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND 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 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 PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR On AU71 RIZED AGENT DATE p <br />eau <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK <br />PROJEDUDDRESS <br />APPLICAhtSCITY BUSINESSLICENSE NO. <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 />I <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 SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />HEATERS—B.T.U. M <br />CLOTHES WASHER <br />_UNIT <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DR.'.IN <br />AIR HANDLING UNIT— r,.F. M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEAUERS <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_— <br />SUBTOTAL <br />(.UB TOTAL $_ <br />PERMIT S <br />_ <br />_ <br />PERMIT s <br />_ <br />TOTAL FEE S <br />TOTAL FEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I <br />r■ <br />