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;�L:PPLICATION FOB,.N <br />a" OF CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT 259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION OLCOMBINATION ❑ BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />�11_ . ci //W AtrV ..?.a4 Fil0hinllrS�'�.4 �J7 as�7 - . <br />PLUMBINOCONTRAOTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />12 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />/)PEW LL7N UL <br />USE OF eN11Lo1NG <br />1 HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED PHIS AP- <br />i�JTI'9 UN� Z' <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL OESCRIPTKJN OF PROPERTY ISHOWN BELOWOR ^I <br />OFWORKWILLBECOMPLETEDWITH WHETHERSPECIFIEDHERE- <br />LOT--J— / BLOCK�/lG��'6�CCy <br />OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />'— <br />ANY OTHERS' ATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OF SHE PERFORMANCE OF CONSTRUCTION. <br />SIG'-URE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />97 a� r r91 <br />APPLICANT CITY BU NESS LICENSE NO. <br />NK)JE 1 ADDRESS <br />50/ Q R.13-/L <br />MECHANICAL <br />PLUM <br />No <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />WATER CLOSET TOILET) <br />AIR COND. UNITS-H. P. EA. <br />REFRIGERATION UNITS-H.P. EA <br />._ <br />BATHTUB <br />C70 <br />BOILERS-H.P. EA <br />LAVATORY WASH BASIN) <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />I!DISHWASHER <br />HOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />ITCHEN SINK 6 DISP. <br />OO <br />WALL HEATERS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />(.XJ <br />EVAPORATIVE COOLERS <br />2 <br />CLOTHES WASHER <br />0-0 <br />WATER HEATER <br />� <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />RANGE HOOD <br />--i$ <br />_3 <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACES CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />WOODSTOVE/FIREPIACE INSERT <br />SINK SERVICE -BAR. ETC.) <br />SUd TOTAL S <br />d <br />SUB TOTAL <br />PERMIT S <br />PERMIT B <br />TOTAL FEE S <br />O <br />TOTAL FEE B <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />