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PPLICATION FOk <br />IR,F,,,P,T,R <br />CITY of <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259•8745 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION O COMBINATION ❑ BUILDING O MECHANICAL <br />❑ PLUMBING <br />od <br />❑ SIGN <br />PLUMBINR CONIRACIOR / MAIL ADDR S CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ DEMOLITION ❑ WOOCSTO.'E/FRPL.INSERT ❑ BUILDING RELOCATION <br />01 WVNRIw51 uI MulM�4P rlwl.n Vnl <br />Z-0© O <br />USE OF HIDING r/-- /'O/yJ� <br />1 e y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHE SAME TOBETRUE 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 CRANTING 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 />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN ANRE OF CON TRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIP I ION OF PROPS A" I SHOWN BE LOW ORA I I ACHFOURCOPIESi I <br />LOI_BLOCA-._-OF <br />n OIECI ADDRESS <br />APPLICANTS CITY BUSINESS VCENSER <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 />I <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 AC UNITS —TONNAGE EA <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T U. M <br />LAUNORYTRAY <br />UNIT HEATERS—B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN i 907 J <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE a/GP <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK(SERVICE-BAR. ETC <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL 3 <br />_ <br />_ <br />PERMIT f <br />PERMIT f <br />TOTALFEE $1 <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />