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A?PLICATION FOR-' EYETEII <br />mO """" CONSTRUCTION .� <br />everett PERMIT,. <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />225�9E..8745 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />I AMF__< R eSc IN54 MAIL ADOREB�� GIIY 21P PHONE �E _ <br />S� seArrGE ��'��' <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENBEF <br />MECHANIC& CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK pI <br />(3 NEW ❑ ADDITION ❑ ALTERATION pFp1 REPAIR ❑ DEMOLITION p1 WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OFAVORK ICOST Of MATERIALS PLUS LABOR) <br />USE OF BUILDING <br />"q" % / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF 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 NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION <br />OR THEOF CONSTRUCTION. <br />SIGNATURE OF CONTRASACCT/OORR OR AUTHORIZED AGENT DATE / <br />X / L -,id, <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_wBBKCK OF <br />/S =I6 s3S <br />f- <br />L O s /s / <br />PROAECTADDREBS <br />2401 f/i4r1GAN0 <br />APPLICMTS 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 TOILE <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-M.P. EA <br />LAVATORY WASH BAST <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK • 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 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 FIREPLACES CHIMNEY <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL ! <br />PERMIT i <br />PERMIT ! <br />TOTAL FEE • <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FEE <br />RECEIPT NO. <br />CONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEE{ <br />VALUATION <br />FEE <br />OF CONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />_ <br />$ <br />OF BLDG. <br />NO OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />= SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />rPEENALTY <br />.ICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />