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TM EYwown 'APPLICATION FO.. <br />GTY OF CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />L] DEMOLITION r! COMBINATION NI BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER UAIL " ESS CITY ZIP PROIiF <br />GN stir 1 DRESS rrr /� �c. /STY g ZIPsiSs�S- <br />AflCI1REC1 OR DESIGNER MAIL ADDRESS Z CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE L'C:NSE <br />_ 34,01E <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE -LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY Z'.a PIIONE LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION WALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VAL DA',JN OF WORK (COST OF MATERIALS PLUS LA90R)- <br />`/, doe _ <br />OESCRIBE WORK/ / <br />/yl /.� > a'a-wr 8Q 1 A e /fix.�S <br />USE OF BU4DING Fpp <br />A&COuc,/A d <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOW THE SAME TO BETRUE AND CORRECT. ALLPROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER' HERE- <br />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 COHSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEDA ENT DATE <br />LEGAL DESCRIPTION GFIROPERTYISIIOWN BELOW OR AITACM FOUR COPIES( <br />LOT— BLOCK _o <br />LTu <br />PROJECTADDRESS <br />APP,ICANTS CITY BUSINI SS LICENSE NO --• <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO, <br />_ <br />TYPE C'= ECIIIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UN17 S—H. P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS--H. P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK & DISP. <br />_ <br />FORCED AIR SYSTEMS-P. F.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B. T.li_ M <br />LAUNDRYTRAY <br />UNIT,iEATF.RS-B.T_U. M <br />CLOTHES WASHER <br />EVAPORATIVE COCLERS <br />WATER HEATER _ <br />_ <br />CLOTHES DRYERS <br />_ <br />URINAL <br />_ <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />_ <br />RANGE ',DOD v <br />FLOOR DRAIN <br />- <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINLFADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR. ETC.) <br />WOODSTOVE/FIRE PLACE INSERT <br />SUBTOTAL <br />_ <br />SUB TOTAL <br />PERMIT S <br />_ <br />_ <br />PERMIT f <br />TOTALFEF. 8 <br />TOTALFEE f <br />_ <br />TYPE OF <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />LOTAREA <br />ST OCCUPANCY GR <br />NO OF STORIES <br />IKLERS REQUIRED ❑ YES <br />APPIICATIONLCC BY IPLANS CHECKEF <br />VACANT SITE <br />OYES LINO <br />)UP <br />NO. OF DWELLING UNITS <br />DUILDING <br />_—� <br />MAX OCC LOAD <br />PLUMBING <br />❑ NO <br />_ <br />MECHANICA I. <br />DINNER <br />PENALTY <br />BY <br />IAPPII FOiISSU4'ICE CY <br />TOTAL <br />FEE <br />FEES 1 <br />f <br />PI AN CIIELK ICE <br />I RECEIPT NO <br />VALUATION I FEE <br />