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.I <br />F <br />t <br />f,r'PLICATION FOR <br />CITE"'°'"" <br />CIT. OF CONSTRUCTION <br />everett• PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING LEFT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWN E9 MAIL ADDRESS CITY ZIP <br />KP n a3erL� OTa c3 Lt3r<Iv1uroc. 0e. c18P <br />HI AR'IECT OR DLSIGNLN MAIL ADDRESS CITY ZIP <br />I�5l ^y3`'�I4yc N L- <br />WIT ZIP <br />ii <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />f..S'i'-% Ry ) <br />5`�-b�l �entizc:l� <br />PHONE IICENSL <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />VII. <br />CL�ATSS OI' WORK <br />( <br />W NEW ❑ ADDITION ❑ At TERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST Ul MAILRIAI S E L OS LABOR) <br />C) -- <br />I <br />INC-)111K V\I — <br />.-- <br />USE orBul,yylc <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 />LEGAL OESCRIPFION OF PROPL9TYISHOWN RELOWORATTACHFOURCOPIF <br />1GW <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br />LOT�Lelocr�-Ol_.�-�AL1"'e' '"� <br />IN OR NOT. TI IE 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 />- <br />SIGNATURE OF CUNT HACTOR OH AUTHORIZED AGENT DATE <br />I <br />� <br />x <br />PROJECT ADDRESS <br />APPLICANT c.," BUSINESS I. ICLNSE NO <br />,o 17 <br />PLUMBING _ __ <br />MECHANICAL _ I <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />{. <br />WATER CLOSET (TOILET) <br />_ <br />C90 <br />AIR COND. UNITS-H P EA <br />BATHTUB <br />(-'t'J <br />RE.FRIGERATION UNITS-H.P EA <br />fI � <br />LAVATORY (WASH BASIN <br />00 <br />BOILERS-H.P EA. <br />hhc <br />^- <br />-- <br />GAB FfNE:PfR_�A:C `T HI�AG EAgr <br />._..� <br />SHOWER_ <br />O <br />FORCED AlR s`_';�T D T U -M EA <br />KITCHEN SINK A THEIR E" <br />Q <br />WALL HEATERS -BTU. "M <br />DISHWASHER <br />LAUNDRYTRAY <br />UNIT HEATERS-B T.0 M <br />CLOTHES WASHER <br />C_`�'�� <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />W <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />�F <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />1` <br />FLOOR DRAIN <br />_ <br />_ <br />AIR 14ANDLING UNIT- C F M. <br />VACUUM BREAKERS <br />STOVE <br />-- <br />- <br />ROOFDRAINS-RAINLEADERS <br />_METAL <br />FIREPLACE 3 CHIMNEY <br />SINK SERVICE-DAR, ETC <br />WOODSTOVElFTREPLACE INSERT <br />`-- <br />SUB TOTAL <br />O <br />_ SUB TOTAI <br />PERMIT_ 3 <br />_ <br />.____._PERMIT 3 <br />�� <br />TOTALFEE 3 <br />TOTAL FEE 3 <br />USE Z( <br />Y-r1 <br />!E OF 81, DO <br />13- IJ Go <br />A c ✓NCO <br />C—•h <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I <br />ARLA <br />511E <br />AUNO <br />IUPANCY GROUP <br />NO OF OWEL <br />It J <br />OF STORIES <br />MAX OCC. L( <br />2 <br />3 <br />NECKED BY IAPPR FOR ISSUAF <br />livnn G _ L <br />V /�/ ��`• FEE/Y F�NLL:�ON <br />FEES VALUATION FEE I <br />BUILDING <br />PLUMBING <br />MECHANICAL. <br />OTHER <br />PENALTY <br />TOTAL <br />Zq 3 <br />O <br />n <br />m <br />J <br />