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1 <br />`APPLICATION FOk FYPT N <br />the EAyrpreeR CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPI. <br />259-8745 rl C-nRARINATION CM BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />7 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CL A5l or WORK <br />Vg HEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODST OVE/FRPL.INSER7 D BUILDING RELOCATION <br />VAI AIIONOr WORK COST OF MAIERIALS PLUS LABOR) <br />i t)eL <br />DESCRIBE WO' nK <br />7 /A.N/ I efj r1i & I <br />usE OFF mua <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />/I �Al L <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />RIPTIONor PRo:ERY(SHOWN BELOW OR ATTACH Foun COPIESI <br />IEr.AL Uts <br />OF WOR K WILL BE COMPLETED WITHWHETHERSPECIFIEDHERE- <br />e yp� tlic nrr� /71(//S/0 v <br />i4 ' <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10. <br />Rlocr_[.[_or <br />GIVE AUTHORITY -.0 VIOLATE OR CANCEL THE PROVISIONS OF <br />VO4. CT �" ` l �ry C) vL) <br />OR LOCAL LAW <br />OR THEHPERFORMAANCE OF CO STRUCTIONNG CONSTRUCTION <br />SIGNATUR CONTRACTOR OR AUT dRIZ AGE % )FI DATE „ <br />` <br />A'A , �,1 <br />NE�! <br />APPU'A <br />SCI1V USWESS LICENSE NO <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE F E <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />AIR CONO UNITS-H.P. EA. <br />WATER CLOSET (TOILE <br />REFRIGERATION UNITS-H. P. EA <br />G. EA. <br />GAASS P. FIRED AC UNITS -TONNAGE EA <br />BATHTUB 'JJ'}T'' <br />2 <br />LAVATORY(WASH BASIN) <br />__= J�-yOj7 <br />0 <br />SHOWER <br />21 <br />— <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINKS DISP. <br />00 <br />WALL HEATERS-B.T.U. A. <br />_ <br />DISHWASHER <br />_ <br />UNIT HEATERS-BT.11 M <br />(: <br />LAUNDRY TRAY <br />lJO <br />EVAPORATIVE COOLERS <br />- <br />_ <br />CLOTHES WASHER <br />i) <br />CLOTHES DRYERS <br />_ <br />WATER HEATER <br />VENTILATION FAN <br />Z <br />0 <br />1J <br />URINAL <br />_ <br />RANGE N000 <br />V" <br />-) <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. %O <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACES CHIMNEY <br />ROOF DRAINS-RAINLEAOERS <br />VJOODSTOVE/FIREPLACE INSERT <br />SINK SERVICE -BAR, ETC. <br />I <br />Lam' <br />Z <br />Oc <br />SUB TOTAL S <br />— <br />SUB TOTAL <br />PERMIT S <br />PERMIS <br />L � <br />� <br />TOTAL FEE S <br />- <br />TOTAL <br />TOTALFEE f <br />VL/ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />REAR;SlOnIES <br />SIDE SETBACK <br />s <br />PLAN CHECK NUMBER <br />F ) 3 8 V <br />PLAN <br />FEE yj <br />� <br />CHECK FEE <br />RECEIPT NO <br />r <br />FRONT SETBACK <br />/d <br />USE ZONE '/ <br />R= 'I- <br />LOT A <br />S), <br />VACANT SITE <br />OYES ,1QNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF COAST <br />///' <br />OCCUU^ <br />NO. OF UWLLINO UNITS�•' <br />/UBUILDING <br />SSIZE <br />OF BLDG NO. OMAX. OCC. LOAD <br />FIRE SPRINKLERS REOUIRED ❑ YES NO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPIILAIION ACC. BY <br />3 <br />PLANS CHECKED BV <br />✓&F <br />APPR. FOR ISSUANCE By <br />L •G• <br />TOTAL <br />_ <br />�-I <br />S <br />z <br />O <br />H <br />m <br />m <br />