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Ti►PPLICATION FOktr <br />R..evPI.N <br />TAE,°'"" CITY of CONSTRUCTION! <br />everett PERMIT <br />TO BE CO;•IPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER // � MAIL ADDRESS CITY <br />YYrr Y» cTYA CYL /-1 «0s a c� 7J5' &-w AL) N� SeG %/�c 64, <br />ARCHITECT OR DESIGNER n MAIL.LDDRE.AS CITY r21P P140PJE <br />GENERAL CONTRACTOR MAILADDRESS CITY IF PHONE LICENSE <br />rVN r' CITY ZIP PHON' LICENSE • <br />MECHANICAL CONTRACTOR MAILADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />CLASS OF WORN <br />Y't NEW ❑ ADDITIONXI <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPI_IJSER7 ❑ BUILDING RELOCATION <br />DESCRIBE WORK <br />USE OF BUILDlr�+G <br />I HEREBY CERTIFY THAT I HAVE REAL) AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />THIS TYPE <br />BELOW OP ATTACH FOUR COPIES) <br />PROVISIONS OF LAWS AND RDINANCES <br />LEGAL DESCNPIION OF POOPERtY(S110VIN <br />WILL BE COMPLETED WITH WHETHOER SPECIFIED HERE- <br />OF WORK <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT— BLOCK­OF <br />TO VIOLATE OR CANCEL THE PROVISIONS Or <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />Tera P-\ ' S�Qrks J U ;v <br />SIGNATUR OF CONTRACTOR OR AUTH IZE0 AGENT DATE <br />/50 <br />APPLICANTS CIT�111SISS SE <br />PROJECT ADDRESS A `.�. M41� �A-i'�y <br />IdOg 5.6. &it- / <br />MECHANICAL <br />PLUMBIN - -- <br />NO. <br />TYPE OF EQUIPMENTWATER <br />FEE <br />TYPE OF FIXTURE <br />AIR RIGERD. UNITSU". EA <br />REFRIGERATION UNITS—H.P. EA.BATHTUBZ <br />CLOSET(TOILET) _ <br />EA.GAS <br />LAVATORY(WASH BASIN) <br />GAS FI ED A.0 <br />FIRED AC. UNTTONNAGE EAKITCHEN <br />FORCED AIR SYSTEMS.U. M EA.WALL <br />SINKA CISR <br />HEATERS—BMDISHWASHEP.LAUNDRY <br />#FEE::NO. <br />UNIT HEATERS—B.T.U. AlCLOTHES <br />TRAY <br />EVAPORATIVECOOLERS <br />WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />-- <br />VENTILATION FAN <br />URINALDRINKING <br />RANGE HOOD <br />FOUNTAIN <br />AIR HANDLING UNIT— C.F.h1._ <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACES CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />WOODSTOVE/FIREPLACE INSERT <br />SINK (SERVICE —BAR. ETC.) <br />Q <br />SUB TOTAL S <br />— <br />SUB TOTAL <br />!<.V <br />S <br />PERMIT S <br />QL <br />PERMIT <br />TOTAL FEE _ 5 <br />TOTAL FEE $ <br />USE ZONE <br />I,1\PI F I1IIN91 <br />-i. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IVIA. <br />aA <br />WA-- <br />Low-w <br />F STORIES <br />SIDE SETBAa <br />VACANT SITE <br />OYES ONO <br />ND. or own <br />O <br />MAX OCC. L( <br />APPLICATION ACC. BY PLANS CHECKED BY r. ....... <br />Sj J L •c <br />d-On <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />VALUATION <br />FEE <br />' T V—CH-i,KILCAt— L L,r 'L'b V=,tf: <br />C)Fbrp_\t"V rD 'PjY f�rtECJ'1'I'. L.CIf.'��I <br />