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`;-APPLICATION FOit everett <br />the EvmgrecR CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COKIFLETcD IN BLACK INK- ?LEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP PRONE <br />ARCHITECT OR DESIGNER <br />MIKE GuR'rts z3S//Y 76 ''/!JEST �ED�No /ys ttin/R Age" <br />_—..__.. .,.....^.^...� MAIL ADDRESS zil PHONE LICENSE <br />PHONE <br />Qllcli-'FY <br />It <br />CLASS OF WORN( <br />Cl NEW Ky ADDITION ❑ ALTERATION Cl REPAIR El DEMOLITION <br />[I WOODSTOVE/FRPL.INSERT El BUILDING RELOCATION <br />VALUATION OF WORK )COST OF MATERIALS PLUS LABOR) <br />T+3, 000 <br />DESCRIBE WORK <br />tige s T I C _ <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />TAVER N - <br />PLICATIONAND KNOWTHESAMETOBETRUE AND CORRECT. ALL <br />ROPERTY (SHOWN BCLOW OR ATTACH FOURCOPIESI <br />PROV; SIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIFTION OF <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />NOT <br />IN NT. THE GRANTING OFA UME TO <br />LOT_—BIOCIL—OF <br />TYTO VIOLATE ORFCANCEL THE PROVITDOES <br />SIONS OFF <br />SIONS <br />GIVOER UOTHOR <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />1_O!`Y S I TB EAT; <br />APPLIC TSC BUSIN'SS LICENSE 110. <br />PROJECTADDRESS <br />�07 5 E F✓�,F£�T MAt� WAY cJ�� A. e:o <br />PLUMBING <br />MECH ICAL <br />FEE <br />NO- TYPE OF FI%Tlla^ FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET(TOILET) <br />AIR COND UNITS-H.P. EA. _ <br />_ <br />REFRIGERATION UNITS-H.P. EA. _ <br />BATHTUB <br />_ <br />LAVATORY (WASH BASIN) <br />__ BOILERS-H. P. EA.— <br />GAS FIRED: C. UNITS=TONNAGE E? <br />_ <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA. — <br />KITC14EN SINK & DISP. <br />WALL HEATERS-B.T.U. M <br />_ <br />DISHWASHER <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />_ <br />WATER HEATER <br />CLOTIIES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN _ <br />S <br />DRINKING FOUNTAIN <br />_ RAiIFC HOOD <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE — <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAINS -RAIN LEADERS <br />_ <br />WOODST VE/FIR PLACE INSERT <br />SINK (SERVICE -BAR, ETC.) <br />,- •2_ <br />it ,i _DO <br />— <br />SUB TOTAL 5 <br />O <br />SUBTOTAL <br />-- <br />PERMIT 9 <br />PERMIT 5 <br />TOTALFEE = <br />0 <br />s <br />TOTAL FEE 5 <br />— <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />z <br />O <br />n <br />rT <br />N x <br />m <br />co <br />m n <br />--I c <br />O 3 <br />m <br />-I Z <br />x -1 <br />m <br />o z <br />C <br />a --I <br />r_ _x <br />O . <br />m <br />__4m <br />x <br />m Ln <br />N <br />C) r <br />n m <br />c N <br />m N <br />m <br />z n <br />fn <br />a <br />A <br />