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R R bT <br />HOCCAA <br />�AAIA 1 <br />"we, <br />APPLICATION FOW <br />the Evergreen CONSTRUCTIONan of <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />TAemn <br />BLDG. PERMIT= <br />26599 <br />BUILDING DEPT. <br />259.8745 COMBINATION ❑ BUILDING MECHANICAL i; PLUMBING ❑ SIGN <br />OWNER MOIL AOOR[GS UC.Ic. Cs CI1Y ZIP PHONE <br />EVERETT FIRE STATION 3619 RMIA Avenue, Everett, WA <br />ARCHITECT OR DESIGNER MAIL ADDRLSS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS l.w ZIP PHONE LICENSE• <br />MECHANICAL CONTRACTOR MAIL ADDRESS LITY ZIP PHONE LICENSE <br />AUBURN MECHANICAL, INC. P. 0. Box 249 Auburn, WA 98002 939-9780 AU-BU-RM-I63 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE BA <br />SAME AS ABOVE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORN (CAST Of MATERIALS PLUS LABOR) <br />INSTALLATION OF FIXTURES AND & GAS PIPING OUTLETS <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAME TOBETRUEAND CORRECT. ALL <br />PROVISIONSOF L AWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LDr_BLocK—OF <br />IN OR NOT. THE GRANTING OF A PERMITDOES 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE y^ <br />X <br />PROJECT ADDRE95 Uat (C� <br />APPLICANTS CITY BUR) SS LICENSE NO <br />3G19.13aer Avenue <br />PLU�.�dING <br />MECHANICAL <br />TYPE OF FIXTURE FEE <br />NO. <br />TYPE OF EOUIPMENT FEE <br />WATER CLOSET TOILE <br />!' <br />. <br />AIR COND. UNITS—H.P. EA <br />_ <br />REFRIGERATION UNITS—M.P. EA <br />BATHTUB <br />LAVATORYIWASH BASIN <br />BOILERS—H.P. EA. <br />_ <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />SHOWER <br />_ <br />KITCHEN SINK S DISP. <br />1 <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—S.T.U. M <br />:LOTHES WASHEfl <br />EVAPORATIVE COOLERS <br />ATETTNEATEIY <br />CLOTHES DRYERS <br />IJRINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />r ; <br />RANGE HOOD <br />s <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERACE—BAR. FTPI <br />W ODSTOVE/FIREPLACE INSERT <br />(I U <br />O <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />