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m <br />F7OH <br />y <br />,oxx <br />C H <br />9HCn <br />ryyti <br />H Y i-i <br />HC O <br />H 77 <br />�J H NH <br />OHd <br />Hag <br />4] O <br />a Hz <br />r z <br />HH <br />gCA <br />H <br />O p VJ <br />rA <br />H O CC12 <br />Me EvmpreeT -APPLICATION Fe..R <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE CGMPLETED IN INK. PLEASE PRINT <br />-_� ❑ DEMOLITION ❑ COMBINATION kBUILDING O MECHANICAL <br />" OWNER 1tjC,JC1y lgN/. MAILAODRESS CITY ZIP <br />eY e • tye1 /Gsr7.J w. 1'w 6,,vo L.�s love <br />ARCHITECT ODESIGNER �'gdxleu MAIL AODRESS CITY ZIP <br />Hoke oeg,,v SeAv,CeS Gi_y liBezTr 19vt�- riARvdv�, <br />RFNERAL CONTRACTOR MAIL ADDRESS �� CRY D ZIP <br />❑ PLUMBING ❑ SIGN <br />PHONE (�.p.�� 3SS=37 <br />Lt%f/ ��Fio 99 p PHONE C,1,4) SO �IESJ <br />old y&�ZTo <br />P..N� LICENSE <br />Cl W AI&Al <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE a <br />PLUMBING CJNTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />Yam. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPL.INSERI ❑ BUILDING RELOCATION <br />VALUATION OF NORK (COST OF MATERIALS PLUS LABOR, <br />DESCRIBE WORK <br />2 1%a2 Gif1.e ;26!w5: <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIVED THIS AP- <br />PLICATION AI VD KNOW TH E SAM E TO BE TRUE AN D COI IRC-CT. ALL <br />PROVISIO NS OF LAWS AN D ORD I NA NCES GOVERNI NG TH IS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIHIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />L GAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOURCOPIESI <br />-dG <br />�/1n <br />LOT�BLOC �DD OF f5 U"po <br />PROJECTADDRESS /yrQ �A/. �vp <br />APPLICANTS CITY BUSINESS LICENSE NO. G <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 />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. E) <br />LAVATORYIWASH BASIN) <br />BOILERS—H. P. EA. <br />_ <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINKS DISP, <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRYTRAY <br />_ <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 />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK(SERVICE—BAR, ETC.) <br />WOODSTOVEIFIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT f <br />PERMIT 5 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />