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SUPPLICATION FOB <br />ol l CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TC BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />CITY <br />O PLUMBING <br />C3 SIGN <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />1,/i�/.., AlrtJpe_I �.t ��l�f AJ,LjK 4G Fdrerst ii.'f? i�raa3 .3Ss7�3n l/,ILLE.UcI1!t - <br />PLU�' IRA�COIITRAC7OR 1MIL ApORES. CITY ZIP PHONE LICENSE <br />CLASBOF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATK)" OF WORK (COST OF MATERIALS PLUS LATION <br />l' ono - <br />DESCRIBE <br />QC '?1 1427& I A.(, �Vl <br />ALL <br />USE OF WILDING <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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTIONOFPROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT- BLOCK 0 <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 OR AUTHORIZED AGENT DATE <br />PRMCT ADDRESS <br />APPLICANTS CITY BUST LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FI%TURE <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 JWASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DIS14WASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />;;LOTHES 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 & CHIMNEY <br />SINK SERVICE -BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />el <br />SUB TOTAL <br />SUBTOTAL B <br />PERMIT • <br />PERMIT 3 <br />TOTAL FEE • <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />