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the Ewfgwn APPLICATION FO <br />CITY OF CONSTRUCTION <br />everett PERMIT �+ <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />259.8745 ❑ COMBINATION Pt BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAR5o�, CI'i 21P PHONE <br />vgc; PA <br />— <br />Evractmr W oar, <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PHONE <br />pp/vbZ.-3n4 wEr►% CX6c r wh R�ZvI L51t3 <br />OENE CONTRACTOR r� MAIL ADDRESS CITY CIF PHONE LILT N'vf A <br />�430C, -I0Cr`=(0 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />I✓AAJn Qrc K'g <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 211, PHONE L-CENSEA <br />CT-lA�S30F WONK --" <br />c> p. /are <br />U NEW ADDITION ❑ ALTERATION ElREPAIR ElDEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK WO��� <br />(COST OF MATERIALS PLUS LABOR) <br />((�� <br />OESCRIIfEN�'ORK <br />�� �� <br />RG{/d ZA /♦ ' 14�5/VC 6�C3 <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOW THE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONS OFLAWSANDORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED 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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGMA TURF OF CON I RAC TOR OR AU THORIZED AGENT DATE`4 <br />!c <br />LEwLDESCRIPTION OFPROPERTY lsrfowNeel,awORATTACHFODRCOPIES' <br />Lor_eLocl�_oF <br />PROJECTADDRESS <br />du" 14M AVE 91E, <br />APT all ❑TV OUSINF otgS t. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I TOI LET) <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 A . UNITS —TONNAGE EA <br />KITCHEN SINK 6 D13P. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. MEAL <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B T U, M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C. F.M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAINL EADE RS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT 3 <br />_ <br />PERMIT 3 <br />— <br />TOTALFEE $ <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />TYPE OF CONST <br />1f— Ij <br />1471 5 <br />ACC BY <br />.J7j_ <br />'T V m <br />SIDE SETBACK PLAN CHECK NUMBER <br />1 FEE <br />VACANT SITE l FEES <br />OYES ONO <br />A <br />NA <br />BUILDING S <br />-- <br />OwCC�1. LOAD <br />7`A <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPA FOR <br />TOTAL <br />FEE <br />FEE <br />