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APPLICATION FOk <br />CITYthe OF CONSTRUCTION <br />CONSTRUCTION `e <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL (PLUMBING ❑ SIGN <br />OWNER, , — MAILADDRESS .�'; T CITY ZIP PIIOIIE <br />OR <br />MAIL ADDRESS <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />_ <br />AIAR, <br />P�LU^/1BI:G CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PUONE <br />ll LNSE• <br />)F <br />/ <br />OW%v✓ESc <br />gLASS OF <br />l ASWORK <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPLANSERT <br />❑ BUILDING <br />RELOCATION <br />AL CATION OF WORN )COST OF MAT':RIAI.S PLUS LABORI <br />OE5CNIBL WORK _ <br />,% //✓.75/47// /- /.9'n YJ//�ln Jw) ¢ /�7l!/,ii a.� //�(lwl. !'l` /w,.111—rc-1"-Ix <br />USF. OF BLIII DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE -SAME 10 BE TRUEANDCORHECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WI fH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCE1 THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR O - UTHORIZ:0 AGL7 DATE <br />X L r7d — — <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT — BLOCK _OF <br />PROJECT ADDRESS <br />APPLICANTS TY BUSIN 'S LICENSE NO. <br />PLUMBING I <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />'EE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />—17— <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H, P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.R EA. <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />— <br />ROOF DRAINS— RAINLEADERS <br />METAL FIREPLACE R CHIMNEY <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />WOODST VE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />