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F.__ _ _ _ <br /> 'APPLICATION F6R <br /> Me EverpFNn <br /> CIT'/OF CONSTRUCTION [e„1 <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O DEMOLITION 0 COMBINATION BUILDING 0 MECHANICAL N.F1PLUMBING 0 SIGN <br /> lrV'.f� C ( 1 MAIL ADDRESS <br /> --/ CITY ZIP PHONE <br /> tom( ! e- ) I`iL k,tr1•-, lit C:-1 S7 t /L 1-Jf-4 `)q-e/ /- / 7r z <br /> •RCHITECT OR DE IGNER MAIL ADDRESS CITY QIP PHONE <br /> .--f\F___ <br /> ,E NE PAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> 4Ltc.: 'rt fS7 LI3 <br /> 'ECHANICAL CONTRACTO MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> • <br /> LUMPING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> • <br /> LASS OF WORK <br /> ❑ NEW 0 ADDITION 0 ALTERATION REPAIR 0 DEMOLITION 0 WOODSTOVE/FRPL.INSERT 0 BUILDING RELOCATION <br /> .tititTioN OF WORK(COST OF MATERIALS PLUS LAPORI <br /> 1.55roBL WORK <br /> l'J� IZLIo-,s�� t,-`-T '. / ??-ezc712 �.1�)e�icn 1`-4-. 1.---f--`4‹..1%r '-' 4 L fes- <br /> TFrfr.Run RING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS Ar- <br /> 1 _fr-IGr Ir1:"1(.___ PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> GAL DESCRIPTION Of PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> It BLOCK OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> • <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIG .ONTRACTOR OR AUTHORIZED AGENT DATE <br /> —56/ X/ ,/,‘,„, k ^,GIECT ADDRE53 / 4,API!LIGANI'&C11Y BUSINESS LICENSE NO. <br /> . T-N.n 9 Iu E. - <br /> LUMBINO MErTIANICAL _ <br /> NO. _ TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT _ FEE <br /> J WATER CLOSET(TOILET) .SJ_ __ <br /> .5-7,- <br /> AIFT COND. UNITS-14.P.EA. <br /> I BATHTUB � REFRIGERATION UNITS—H.P.EA. <br /> f LAVATORY(WASH BASIN) BOILERS—H.P.EA. <br /> A SHOWER GAS FIRED A.C.UNITS—TONNAGE EA <br /> ( KITCHEN SINK 8 DISP. __..:5 FORCED AIR SYSTEMS•-B.T.U. M EA. <br /> _DISHWASHER 3 WALL HEATERS—B.T.U. M __• <br /> LAUNDRY TRAY _ UNIT HEATERS—B.T.U. M <br /> / CLOTHES WASHER —, <br /> __.....i..._._ VAPORATIVE COOLERS <br /> A.16R++E-ATER-- 1 CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE 11000 <br /> FLOOR DRAIN AIR HANDLING UNIT— C F.M. <br /> VACUUM BREAKERS __ _ STOVE _ ___ <br /> ROOF DRAINS—RAINLEAUERS METAL FIREPLACE 8 CHIMNEY <br /> SINK(SERVICE—BAR.ETC) _ WOCDSTOVE/FIR PLACE INSERT <br /> -) — ttnZJa — <br /> SUB TOTAL _ __ SUB TOTAL S <br /> PERMIT $ PERMIT S _ <br /> TOTAL FEE $1— <br /> _ <br /> TOTAL FEE S __ <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> 'IT SETBACK REAR SETBACK SIDE SET BACK PLAN CHECK NUMBER FL AN CHECK FEE <br /> FEE RECEIPT NO <br /> LONE LOT AREA VACANT SITE <br /> OYES ONO FEES VALUATION FEE <br /> OF CONST OCCUPANCY CROUP NO.OF DWELLING UNITS <br /> BUILDING S <br /> OF BLDG NO OF STORIES MAT.OCC.LOAD — <br /> PLUMBING <br /> MECHANICAL <br /> 1SPRINKLERS REQUIRED I]YES 0 NO <br /> OTHER <br /> PENALTY <br /> 'CATION ACC BY CLANS CHECKED DY 1AFPR FOR ISSUANCE BY -- <br /> ' TOTAL <br /> L C' <br />