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t;;PPLICATION FOE.-,,: <br />evereB <br />NIT EOArOFes^ CITY of CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑�lt+K i'.`ESELIIJ G <br />DEMOLITION ❑ COMBINATIONX�NLMT`19I-(�O_MKCHANIICAL ❑ PLUMBING <br />493 ❑ SIGN <br />PHONE <br />MAIL JAJS72�1/�2Q <br />OVI14ER 10"0"cps IWD 7 <br />rf7 <br />- CITY / �F�p L. ��/ <br />ARLNTFCT On DFSIGNER i�'�55 �..(M I/�-rZ AJE Ft/ ( TIW�• /�JW/� Li586 <br />F/N[Ey/�GY1tT�` G. I i1t <br />MECHANICAL CONTMLTOR <br />ISE. <br />MAIL ADDRESS LILY ZIP r110N[ LICG <br />PLUMDINO CONTRACTOR <br />MRIL ADDRESS CITY Zlr PHONE LICENSE. <br />;OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODST``OVEE/FRPL.INSERT BUILDING RELOCATION <br />OR <br />INoN nvsi/�.�Q� A!I:. s nB'—r0�j, <br />wi <br />LOTS <br />36-E ATp4z",D <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TOGIVE NS . <br />ANY THERTOSTATE OR LOCATY TO L E OR CANCEL THE LAW REGULATING CONSTROUCTION <br />i'-ffTE-�ER0 IqEQF VQN5lHUI:I HJ rv. <br />/SIGN TUBE C 'CON T O 1UTH RIZED AGENT DATE <br />APPI CANTS IYBUSIN SSLICENSE NO - <br />PRO E TADDRESS _ <br />��G(r S�" Ilr,rr�lildlll'l�'� <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE — <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />AIR COND. UNITS—H. <br />FEE <br />NO. <br />WATER CLOSET;TOILET) <br />REFRIGERATION UNITS <br />BATHTUB <br />BOILERS—Ii.P. EA. <br />LAVATORY (WASH BASIN; <br />GAS FIRED 0.C. UNITS —TONNAGE EA <br />� <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />— <br />WALL HEATERS— <br />KITCHEN SINK A DISP. <br />DISHWASHER <br />UNIT BEATERS—B.T.U. M <br />LAUNDRYTRAY <br />— <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />-_— <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />_ <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />_ <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAINS—RAINLEAUERS <br />WOODSTOVE/FIREPLACE INSERT <br />SINK ;SERVICE —BAR. ETC.) <br />SUB TOTAL s <br />SUBTOTAL <br />PERMIT s <br />" .. 'AIT s <br />— <br />TOTALFF.E s <br />. AL FEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT ^v;Cy <br />PEARSEIPrILK <br />WOE�EIOSADK <br />USE ZO�NF. <br />GI <br />LO,TfARFA <br />T T—T/ L/ I <br />VA ANTSITTE <br />TYPE Of 7JNST. <br />y'1 kK <br />OCCUPANCY GROUP <br />13'1 0•7-11413 <br />NO. OF DWELLING UNITS <br />--- <br />SIZE OF RLOG <br />NO OF STONES <br />1 <br />MAX OCC. LOAD <br />5s2om-:w <br />1. <br />-,5-009- <br />13p 2 <br />FIRE SPRINKLERS REOUIRED <br />I1 YES NO <br />Arm ICATION ACC BSI <br />PLAITS CHECKED BY <br />RPPR.FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />FEES <br />s <br />VALUATION I FEE <br />