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APPLICATION FJ ee <br />tho F°'�° <br />CITYOF CONSTRUCTION O <br />ltt O <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 El COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />ZIP <br />ZIP <br />CITY ZIP PIIONC LICENSE• <br />LUMBING CONTRACTOR /f MAIL ADDRESS <br />N <br />'LASS OF WORK <br />❑ ❑ REPAIR <br />[IDEMOLITION ❑ WOODSTOVE/FRPL. INSERT BUILDING RELOCATION <br />NEW ❑ ADDITION ALTERATION <br />IALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />G»1 T2 uc-T <br />I F EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />JSE OF BUILDING <br />PRCVISIO AND KNOW THE SAME TO BETRUE AND CORRECT. ALL <br />S <br />)_ <br />VIRKWILLFLAWS AND ORDINANCES <br />PROPA/L <br />LEGAL DESCRIP110~N10AF-PNOPERI I w—wN BELOW oRA A NFOI RcorIE <br />WHETHEGOVERNING CiFIE ERE- <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />OF <br />�1 �I�Jf1�V( <br />` <br />O <br />IN OR NOT. THEGRANTING OFA PERMITDOES NOT PRESUMETOr <br />LOT- a SLOCK— OF--K-1 <br />TY <br />GIVE TO VIOLATE OR CANCEL THEANYO <br />HER STIATE OR LOCAL LAW REGULATING CONSTROUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTR .TOORR OR AUTHORIZED AGENT DATE <br />%� 1 iAL7U�n� %' Z3- eS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PROJECT ADDRESS <br />I <br />V <br />MECHANICAL <br />FEE <br />PLUMBING <br />FEE NO. TYPE OF EQUIPMENT <br />NO. TYPE OF FIXTURE <br />AIR COND. UNITS-H. P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UTATS-H.P. EA. — <br />BATHTIJB <br />BOILERS-H. P. EA. <br />LAVATORY (WASH BASIN) <br />GAS FIRED A.C. UNITS -TONNAGE <br />_ <br />SHOWER <br />FORFED AIR SYSTEMS-B.i. Ul M EA. <br />KITCItFN SINK f DISP. <br />...uceTPNS—RT11. !A _ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />26 FT <br />USE ZONE <br />V I <br />TYPE OF CONST. <br />V-0 <br />SIZE OF BLDG <br />/" 2"f- S. F, <br />VACANT SITE <br />OYES WV6 <br />140. OF DWELLING <br />NA <br />MAX. OCC. LOAD <br />ONACC.BY I PLANS CHECKED BY <br />k5u 4W4,n E . c. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEES <br />FEE 5"23 IRELH N� <br />VALUATIONIto, t6D. <br />FEE <br />I.ILD <br />