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the Evsrprsan y`.iPPLICATION FOt evereU <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING <br />❑ MECHANICAL <br />❑ PLUMBING <br />A SIGN <br />OWNER <br />MAIL ADDRESS �7r3f'`,y° <br />w•� Ne-' �'I T. r Sr �. <br />PHONE <br />iItLS'J11C'N� <br />-c F_•.I�C LSITTZ- Tv�i. G.-rvt�r <br />w/1 . �Ebri". <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GE NEPAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />._..1 `•{'i_ (IlT^j" <br />r . <br />\ L't' r�')(<I /))��r- C: �T'C a'7 <br />.17i�.r-i ... 'G' <br />Ji': .. �7i is <br />rl..r.f'..'L. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT U BUILDING RELOCATION <br />VALUA 11 OF WORKICOSI OF 1AATCRIALSPWSLABORI <br />, r..S!i <br />DESCRIBE WORK <br />�.�-iL-,. F�rc _,..o._ -.>. 1I�'_•w Y ern/ YJ.l.Y, }7 �- r1 Fa' c�.t,7 l--f ikk/* S, ta� <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER IER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OFC/ONTBACTOR OR AUTHORIZED AGENT DATE <br />APPLICANTS CITY BUSINe ICE SE RT <br />LEGAL OESCRIPT 1014 OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK _OF <br />PROJECTADDRESS <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 />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA, <br />_ <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 />WATER HEATER <br />I 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 & CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT 5 <br />PERMIT & <br />TOTAL FEE S <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />