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=APPLICATION F(�%R <br />CITE"'°"'R <br />CITY OF CONSTRUCTION 4everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION <br />❑ BUILDING <br />MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />f%rA/c/ <br />6,�/lNtJ /�N/� <br />.0 <br />C'll�il�lNia <br />yt'� -r7 /ci/?-S <br />ARCHITECT OR DESIGNER <br />C11 <br />MAIL ADDRESS <br />f f,J <br />1 <br />CITY ZIP <br />Sil <br />PHONE _ <br />H/1 /11 C/ SC IV (j ` FI <br />yi I <br />/d /Q,S <br />iP/c 601 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />FHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />D/Awo/vid W" i'/hq !1/� h'�X 9d" i 7?'1-S 6ed 01AM09PzsB <br />PLUMBING CONTRACTOR / MAID DRESS CITY ZIP PHONE LICENSE <br />N/ A- <br />❑ NEW ❑ ADDITION R_ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERr ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />_ �d <br />DESCRIBE WORK <br />.T/Vs 7T!/I 3 3 jc/IM C oi�S <br />USE OF BUILDING <br />,G��s�N� <br />1 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 TH IS 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 LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT OF CONT - f.TOR OR AUTHORIZED AGENT DATE <br />X l / G ems' <br />LEGAL DESCRIPTION PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT - BLOCK _OF <br />PROJECTADDRESS <br />/'gAAJO 4NX <br />APPLI ANTS CITY B NESSLICENSENO, <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE_ <br />NO. <br />TYPE OF EQUIPMENT <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 />BOILERS-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 WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />HOOF DRAINS- RAINLEADERS <br />METAL FIREPLACES CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT f <br />TOTALFEE f <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />USE ZONE I LOT AREA VACANT SITE <br />OYES ONO <br />TYPE OF CONST. locCUPANCY GNOUP NO. OF DWELLING UNITS <br />APPLICATION ACC. BY I PLANS CHECKE D BY I APPR. FOR ISSUANCE <br />FEE IRECEIPT NO. <br />FEES <br />BUILDING $ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />VALUATION I FEE <br />