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PPLICATION FO►.. evereR <br />the EveryrNR CITY OF CONSTRUCTION e <br />CITY <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING D9 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS Cltt ZIP PHONE <br />✓l R.std �Y1 rt� �//1 /`SIC ADDRES 1��� l�n �(�1 <br />ARCHITECT OR DESIGNER / I MAIL ADDRESS �/� CITY [ ZIP HONE <br />A ;; �l N( l 4� ficic Jo A) 1� S'� Y AAt&'•/l r ' lyl�� � Is-) Y2-z-61f3o <br />/ PHONE LICENSE <br />GENERAL CONTRACTOR <br />MAILADDRESS CHI <br />4-9/0 J_:e¢ hh,� 9�✓�A/ rwL?al <br />21P <br />K.lk4�_L�053{kits'-of•✓) <br />LICENSE <br />MECH NICAL CONTRA OR <br />MAILADDRE55 <br />2P P ,,ONE <br />F� <br />-f /yCI�TY <br />/N z7 S i�e� un t �` J a7Ui <br />i�i//n� 76 3 <br />17�f TL �✓E ZP2e <br />AOA rO0i1 e Q�.4d <br />�n..oerm <br />MAIL ADDRESS OITY <br />ZIP PHONE <br />LICENSE• <br />CLASS OF WORN <br />Od NEW GY ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT Cl BUILDING RELOCATION <br />VALUATION OF WO iCOST OF MATERIALS PLUS LABOR) <br />�r 'mo- - <br />DESCRIBE WORK I <br />I� <br />1 <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />- 1 <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF PROPERTY (SHOWN BELOW OR ATTPCH FOURCOPIES) <br />LEGAL DESCRIPTION <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 />I <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE X C'a— S-11./ f� <br />APPLICANTS <br />CITY EMSINESS LICENSE NO. <br />PROJECTADDRESS <br />�l <br />r sLZE W <br />o aS 7/ . <br />MECHANICAL <br />PLUMBI <br />NG <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS-H. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />-Z <br />GAS FIRED A C. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AlR SYSTEMS-B.T.U. M EA. <br />KITCHEN SINK & DISP. <br />2- <br />WALL HEATERS-B.T.U. M ti tzL <br />DISHWASHER <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />WOOD TOVE/FIR PI ACE INSERT <br />SINKISERVICE-BAR, ETC. <br />M 3h <br />SUR TOTAL 5 <br />Ov <br />S <br />IS <br />PERMIT $ <br />- <br />PERMIT <br />TOTAL FEE $ <br />TOTAL FEE S <br />_�/'> <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />