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APPLICATION FiII,.R <br />CITY OF°'"" <br />CONSTRUCTION <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 ❑ SIGN <br />OWNER <br />MAIL ADDRESS } CITY ZIP <br />N.L' sbillf�Yst't�Ce <br />PHONE <br />9 2?u <br />ARCHITECT OR DESIGNER <br />MAIL ADDFlESS CITY ZIP PHONE <br />(� �' ` <br />C_R%s*3j ) CVSTuoi <br />fin/ ,^, <br />r %Nyops- L I-I'L 713 sC II IYgU w.1 ZP <br />I�IPNONE <br />ITY <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY Z:P PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVc/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />132 oun <br />DESCRIBE WORK <br />lil..l n (D -r nIBf <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />1?e'--N 1I)L <br />PLICATIONAND KNOWTHESAMETOBETRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR AVACH FOUR COPIES <br />pI1 ZZ P )I^r <br />LOT_BLOCK 1 of lam. <br />OFWORKWILLBECOMPLETEDWITHWHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR O IZED AGENT DATE <br />11115 <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />*126 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET JTOILETI <br />AIR COND, UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVALORY(WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINKB 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 />_ <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-RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL s <br />PERMIT D <br />PERMIT s <br />TOTAL FEE s <br />TOTAL FEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />Ii:URH <br />USE ZONE I LUI AIM- I VACANT SITE <br />OYES ONO I <br />TYPE OF CONST. <br />GROUP <br />FIRE SPRINKLERS REQUIRED OYES ❑ NO <br />ACC BY <br />BY <br />UNITS <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE I RECEIPT NO <br />FEES VALUATION I FEE <br />