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CITY OF'vIN^ � � ,P P L I C A T I O N F O..' everetl <br /> COf� STRUCTiON <br /> everett PERMIT � <br /> BUILDING UEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK• pLEASE PRINT <br /> ❑ DEMOLITIUN ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> owr�eu c1 Mu�noonss cm nr• cnoHe <br /> c�lAn.��11 �ISII.�L I O�D LfS�til�u�tcQ ������—�,�`.)�� <br /> eacNnec�onoeswr+ea rnniieooness cm zir vnoNE <br /> GENEAAICONiNALIOR M�ILAOpRE55 CI1V Zip PIIONE <br /> LI�ENSE• <br /> M. �IANIGLCONiO�G10fl MAILADORE55 CItY ZIP V9�OM1[ IIf;Eq5[• <br /> ��c� t v,�.r� Q G�u.�, `�,�,w�� Ilo3��� E �11av�,� l� ,,.� � ����.0� �U�r�i�c,,l-:•3�I Y �I <br /> PIUMHiN.LON18�C10R MAILAOpRE55 �IIY ZIP P�IONE lIC[NSC.• <br /> CUSS OF WOtiN <br /> ❑ NEW ❑ ADOITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WpO0S10VE/FRf'L.INSERT ❑ BUILDING RELOCATION <br /> VRLWf10NOFWORN�COSiOFMAiE IAL PWSL/BORI <br /> oesCniu[wone <br /> �:1•�+� L'•7C - WU11G+,fi� �' <br /> p3 r euaou�c <br /> I fiEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> � PLICATION AND KNOW THE SAMETO BE TRUEAND CORRECT.�LL <br /> iee iOESCRIPt10NOFPROPE8fY�5HOWNBEIOWORRTTRC11F0URGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � OF WORK WILL 9ECOMPLETED WITH WHETHERSPECIFIED HEFE- <br /> ior_eiocn—or IN OR NOT.iHE GRANTING OF A PEFMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATt OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REG ULATING CONSTRUCTION <br /> OR THE PEqFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF COIlTRACTOR OR 4UiHORIZED FGENT DATE <br /> X �� I� ��l��wv �.�- i,�-�� <br /> PROJEGT.00RESS qPPLICr1N SCIiYBU IESSUCENSENO <br /> �� -Q lQ LCfYvI�Q <br /> PLUMBING y M[CHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TVPE UF EOUIPMENT FEE <br /> WATER CLOSE7�701LED qlR COND. UNITS—H.P.EA. <br /> BATHTUB R[FRIGERATION UN:T$—H.P. EA. <br /> IAVATORY�WASH BASIN) p01LERS—H.P.EA. <br /> SHOWER GAS FIflEC AC.UNITS—TONNAGE EA <br /> KITCHEN SINK 6 DISP. F'ORCEU AIR SYSTEMS—�B.T.U. M EA. <br /> DISHWAEHEF WALLHEATERS—B.T.U. M <br /> LAUNDRYTRAV UNITHEAiERS—B.T.U. M <br /> CLOiHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATEP CLOfHES DRVERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN qANGE HOOD <br /> FLOOR Oi7AIN AIR HANDLING UNIT— flF.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF CRAINS—RAINLEADERS MEiAL FIREPL�CE d CHIMNEY <br /> SINKISERVICE—BAF,ETC. WOODSTOVE/FIREPLACEINSER7 <br /> SUB TOTAL SUB TOTAL S <br /> PEf7MIT S PERMIT S <br /> _ TOTALFEE f TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> fqOMSEIBRCK FEAqSEiBACK $IOESEiBACK PLANCHECNNUM�ER �LANCnECNVEE <br /> LEE AECEIPL NO <br /> USE20NE LOiARER yqCRNTSIiE -- <br /> OYES ONO FEES VAlt1ATION FEE <br /> ttPEOFLONSi. OCGUPANLYGROUP NO.OFOWEILINGUNITS <br /> 6UILOIN4 f <br /> 512E OF OL00. NO.OF SIORIES MF%.00C.LOAD <br /> PLUMBING <br /> MECHANICAI <br /> FIRE SPRINKIERS REOUIRED ❑YES ❑ NO <br /> OTHER <br /> PENALIY <br /> �PPLI�AiIONRCCBY PLANSCHECKEDBY APFR.FONISSUANGEDY — <br /> TOiAL <br />