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cl <br />1i <br />tAPPLICATION FOk <br />the CITY OF Ewrynen <br />LR <br />CONSTRUCTION <br />[461 <br />everett <br />PERMIT . <br />TO BE COMPLETED IN BLACK IN::— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ <br />PLUMBING ❑ SIGN <br />U <br />OWNER 11�� ((�� <br />Po. <br />MAIL ADDRESS CITY q ZIP <br />&, `S GUG IG /S S, <br />PHONE <br />J)t/I <br />(/JllL ii14 <br />�Gr7 <br />ZIP <br />I—. <br />PHONE <br />ARCHITECT OR DESIGN ER F <br />LAN- fl><��- e <br />MAILAVUHL5b CITY q <br />GSIr/ l o.,4e <br />CITY ZIP <br />PHONE LICENSE• <br />G ERAL LONTRADTCRv <br />r nn <br />MAI L ADDRESS <br />�f) 304� CL�c�o q�l?A`5 <br />ot�Inwrt��T Uf��a�� <br />MECHANICAL CONTRACTOR I <br />of ¢cam -� lip.I: <br />MAIL ADDRESS Lltt <br />P ONE lCENBE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE+ <br />yC2 <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORKICOST OF MATERIALS I—S LABOR) <br />'Vl.tl �tJ'1^'k� t'10•n OI SO <br />i-L... Qi'�p(L. �l<'.LMG 2- L va <br />eb!% OILN <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AN EXAMINED THIS AP- <br />Q.�.F� yQ_ <br />PLICATION AND KNOWTHESAMETO BETRUEANDCORRECT. ALL <br />LEGAL DESCRIPTION OF PP.OPERY(SHOWN BELOW OR ATTACH 1OURf.OPlE51 <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OFWORKWILLBECOMPLETEDWITH WHETHER SPECIFIED HERE- <br />I^� ����qp/ <br />F <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />LOTA8?BLOCK-(4 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />_ �• i� ( <br />/LS% 5 O-T" W mil•/��- �-�LQ r�._p1- <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />6 e-S <br />OR THE PERFORMANCE OF CONSTRUCTION. // <br />f l <br />1 c �' C I S 70, <br />} ,��L�eL,lAli <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ° l" oWwe2 <br />LL <br />GI � �4 VI In <br />PROJECT ADDRESS /- <br />4 — <br />APPLI SLI BUSINESSLICEN 11 <br />�LI!re <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />WATER CLOSETITOILETI DO <br />AIR COND. UNITS-H.P. EA <br />REFRIGERATION UNITS-H.P. EA _ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA O <br />KITCHEN SINK& DISP. <br />FORCED AIH SYSTEMS-BT.U. M A. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />FAN Q <br />URINAL <br />.sJ VENTILATION <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT- L.F.M. <br />If <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS -RAIN' <br />WO QDSTOVE/FIREPLACE INSERT — <br />SINK SERVICE -BAR. ETC. <br />__ <br />SUBTOTAL <br />SUBTOTAL f <br />/ <br />_— <br />PERMIT <br />TOTALFEE f <br />TOTAL FEE f <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />USE ZONE LOTARER VACANT SITE <br />OYES GNO <br />TYPE OF COHBT, OCCUPANCY GROUP NO. OF OWElLIN6 UNITS <br />•.P. �z . r„ I I/ <br />S' I=. I z <br />41 <br />APPLICATION ACC, BY PLANS CHECKED BY I APPR FOR 15SUANUL B♦ <br />BUILD.NG <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEES <br />FEE l/� <br />VALUATION <br />S <br />FEE <br />