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HPPLICATION FOk' !YlFtN <br />C CITY OF EYErOroo^ CONSTRUCTION e► <br />CIT <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAR AOOPESS CITY ZIP PHONE <br />Geor9NGQ-11 as�81&31 Ale, f-leS 34--j-oo75' <br />Cltt IP PHONE <br />CITY ZIP PHONE LICENSE <br />GENERAL CONTRACTOR <br />MAIL AGGRESS <br />CITY 21P PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />GIN ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADOn ESS <br />CLASSOF WOnK <br />❑ NEW 0 ADDITION X ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT BUILDING RELOCATION <br />vnl nn Nrin rn W�InK ILU'll rn Mnn'nlnl ^.Polo Lnnunl <br /># y000 — <br />DESCRIBE WORK , n / <br />on <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 LAWS AND 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 RSTATE TY TO VIOLATE Oil CANCEL THE PROVISIONS Or <br />ANYOTHATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAqRS0 CONTRACTOR OR T ORIZED AGENT DATE p <br />APPLICANTS CII /�IB 6NESS LICE ENO. <br />.PROJECT ADDRESS <br />aI�R iYle <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. TYPE OF FIXTURE <br />AIR COND. UNITS—N.P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS—H.P. EA. <br />BATHTUB <br />BOILERS—H.P. EA <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AiH S,STEMS—G.T U. MCA. <br />KITCHEN SINKS DISP. <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C.F.M. <br />PLOOR DRAIN <br />— <br />S10VE ... _ <br />___ <br />VACUUM ❑NCAKEII.^^= <br />METAL FIREPLACE A CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />WOODSTOVE/FIREPLACE INSERT <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL s <br />SUB TOTAL <br />PERMIT s <br />PERMIT $ <br />TOTAL FEE s <br />TOTAL FEE _ s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIDE <br />v/f 7 <br />USE ZONE LOT AREA VACANT SITE <br />/` , 7 111 OYES /AID <br />TYPE OiNSTI�m,•-,-11 -�_..I- <br />a 5P <br />BY <br />TEE�n s—� I REC�Iiy o � / <br />FEES VALUATION I FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />