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I <br />:-APPLICATION FGR <br />sl"s �s <br />evereR <br />CITE"`°`"° <br />CITY OF <br />CONSTRUCTION <br />e <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK -- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ® <br />SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PIIO4E <br />SF�_ F v z =T _T_ r11 ALL 1 J/v <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS GIN 21P <br />PHONE <br />D <br />D <br />GENERAL CONTRACTOR <br />B <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />I-Bco-,$6n-7.8s� <br />LICENSE+ <br />t <br />TJB4A2T—�Ib <br />/� Po.�)ox� lasl4 �EprnE 98109 <br />(MAIL <br />sLgµ-ow'c TU6EAD311Q.5 <br />MECHANICAL CONTRACTOR <br />ADDRESS CITY ZIP <br />PIIONE <br />LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />I`J' NEWy^ [3 ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ VJOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WpRKICOST OF MATERIALS PLUS LABOR) <br />Y9Y6 D <br />DESCRIBE WORK �7 <br />Gib -�lL1h1S <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNO W TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIVIED HERE- <br />LOT_BLOCKL OF <br />IN OR NOT. THE GRANTING OF A PERN11T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO N3 Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGFIAT_ DATE <br />x (_AL1�y� „ 8'3_ <br />PROJECTADDRESS <br />APPLICANTS CIT USMESS LICENSE NO. <br />8 t l avraiZM= <br />3D 902 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />AIR CONE. UNITS-H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA. <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS _ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEA-- <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE -BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTALFEE f <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIDE <br />USE ZONE LOT AREA I VACANT SHE I FEES <br />OYES <br />OYES UNO <br />TYPE OF CONST OCCUPANCY GROUP NO. OF DWELLING UNITS <br />BUILDING <br />SLOG NO. OF STORIES MAX OGG, LOAD <br />PLUMBING <br />MECHANICAL <br />PRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />d ION ACC. BY PLANSCHECKED BY APPR. FOR ISSUANCE BY <br />__ N TOTAL <br />Q�4lfc�_ <br />FEE RECEIPT NO, <br />VALUATION FEE <br />S�f/nlelfl <br />J <br />r <br />