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1M Ewg,fon APPLICATION FO.\ eTOret1 <br />DITTO, CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION 0 COMBINATION ❑ BUILDING JXIMECHANICAL ❑ PLUMBING ❑ SIGN <br />TVNER MAIL ADDRESS pITV LP PHONE <br />/V dJU/ins �.r3 7 �/''��T <br />nn�nncw UnueIDuncn MAFL AUNHtUU CITY -ZIP PHONE <br />n u,./t-,t, <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICFNAF. <br />LV_ NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODRLIVF/FPPI INCFPT rl <br />u5E OF BUILDINn �., /� <br />r- / / ✓=✓ "d ? <br />ti..J(i YI - lL�I J./,�L:/' �C=J/f�J'%l \_I(. �—' <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHE SAMETO BE TRUE AND CORRECT ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES )JOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEG AL DESCIIIPNON OF PROPERTY (SHOWN DET W OR A ITACH FOUR COPIES) <br />LOT_Bl,ocl`_oF <br />PROJECT ADDRESS <br />APPLICANPS City BUSINESS LICENSE NO <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY ( WASH BASIN) <br />GOILERS—H. P. EA. <br />SHOWER <br />GAS FIRED A.C. 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 />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES."SHER <br />EVAPORATIVE COOLERS <br />_ <br />WA*e~AER <br />✓ <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RA114LEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR, ETC.) <br />ODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT A <br />PERMIT IT <br />! <br />TOTAL FEE IT <br />_ <br />TOTALFEE _ I <br />yl- <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />FEE <br />VACANT SITE OYES ONO I FEES I VALUATION <br />BUILDING S <br />LOAD <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />RECEIPT NO <br />ACC BY <br />