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,.PPLICATION FOhL <br />CITE""°"'" <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN FLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 Ej COMUINATION ❑ BUILDING ❑ MECHANICAL <br />OWNER MALL AOCRf.SS CILV ZIP <br />ZIP <br />❑ PLUMBING SIGN <br />PHONE <br />PLUKUNNGCONTRACTOR MAILAODRESS CITY ZIP PHONE LICENSE <br />BUT WUh?% <br />NEW ❑ ADDITION ❑ ALTE.9ATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT El BUILDING RELOCATION <br />DESCRIBE WORT( <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />DESCRIPTION OF PROPERTYISMOWN BELOW OR ATTACl/FOUR COPIE51 <br />LEGAL <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_BLOCK —OF— <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. 7 [� <br />OTHORIZED AGENT DATE <br />— <br />SIGNATUa;z <br />X <br />APPLICAN CITY BUSINESS LICENSE NO. <br />PROJECI ADDRESS <br />h. e <br />1'40 <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FI%TUBE __ <br />AIR COND. UNITS—H.P, EA. <br />WATER CLOSET(TOILET) <br />REFRIGERATION UNITS—H.P. EA <br />— <br />-- <br />BATHTUB <br />BOILERS—H.P. EA - <br />LAVATORY (WASH BASIN) <br />GAS FIRED A.C. UNITS —TONNAGE EA -- <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />KITCHEN SINK & DISP. <br />WALL HEATEFlS—B.T.U. M <br />_ <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />— <br />LAUNDRY TRAY <br />. <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER NEATER <br />VENTILATION FAN <br />— <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />STOVE <br />— <br />VACUUM BREAKERS <br />METAL FIREPLACE' CHIMNEY <br />ROOF DRAINS -AA INLEADERS <br />WOODSTOVE/FIREPLACE INSERT <br />— <br />SINK (SERVICE -BAR, ETC. <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT $ <br />PERMIT 5 <br />P <br />TOTAL FEE $ <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNtL <br />