Laserfiche WebLink
r'PPLICATION FOP BYlZER <br />the °"" OF CONSTRUCTION ue <br />Cl"CRY OF <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�CITY ZIP PHONE n�c� it <br />j (l!1_C ICK- <br />I <br />ZIP <br />PHONE <br />CIIIIECTORDESIGNER <br />MAIL ADORE9� <br />CITY <br />I 6E7RAL CCNIRAGI00 <br />MAIUDDRE59 <br />CITY <br />ZIP <br />PHONE - <br />LICENSE• <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE • <br />LIFCHAN6Al CONT FACTOR <br />+ RUMBINO CONTAACLOO <br />MAIL ADDRESS <br />CITY <br />- ZIP <br />PIONE <br />LICENSE <br />C.0 'I <br />J lLAS901WORK <br />❑ Cl REPAIR <br />ClDEMOLITION <br />❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION <br />ALTERATION <br />VALUATION OF WORK 'COS' Of MATERIALS PLUS LABOM <br />DE9DRIBT. WORN Z <br />1_ � �� <br />�-A-i �I / n <br />'-A / !iT_.. <br />1S;4Ci,L.t ( ,I!-i Z.JVL.-\vIL_ I `L <br />. <br />—L_' <br />DBeoF F1UILDINO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />F <br />2��� -f��—_ <br />PLICATIONAND KNOW THESAME TOBETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />BELOW OR ATTACH FOUR COPIES) <br />LEGAL D'.SCRIPIION OF PPOPEHIY'9NOWN <br />' <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />Lol_eLoclL--oF <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 />APPLICANTS CITY BUSINESS LICENSE NO <br />PROJECT ADORES9 <br />MECHANICAL <br />PLUMB) <br />NO <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF E ENT <br />FEE' <br />NO. <br />A. <br />AIR UNITS—H.P. EA. <br />WATER CLOSET TOILE <br />RIGERCOND, <br />REFRIGERATION UNITS—H. P. EA <br />BATHTUB <br />J <br />BOILERS—H.P. EA. <br />' <br />LAVATORY WASH BASIN) <br />OAS FIREDDA.C.AUNITS —TON AGE E0. <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />KITCHEN SINK & DISP. <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS—flT,U. M <br />LAUNDRY TRAY <br />EVAPORATIVE CC OLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />' <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />DRAIN <br />AIR HANDLING UNIT— CF.M. <br />FLOOR <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE 9 CHIMNEY <br />ROOF DRAINS—RA'NLEADERS <br />SINK SERVICE —BAR ETC. <br />WOODSTO E/FIRE LACEIN ERT <br />SUB TOTAL B <br />SUB TOTAL <br />PERMIT f <br />PERMIT B <br />_ <br />TOTAL FEE <br />TOTALFEE _ t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />