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the EwrprNn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />APPLICATION FO.. �YEfeH <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL ADDRESS CITY ZIP PHONE <br />IAE HANIUI CONTRACTOR MML AGGRESS , I CITY LIv vnUNE LICENSL <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE LICE16E• <br />CLASS OF WORK ,�(/ <br />❑ NEW ❑ ADDITION ❑ ALTERATION FJ-REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL W TION OF WORK ICOST OF MATE RIALS PLUS LABORI <br />i t,s <br />DESCRIBE WORK <br />• I- I _ I IV. <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION ANDKNOW THESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUI.)E 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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEDA'OESCRIPIIOII OF P OPERTYISBUWN BELOW OR ATTACH FOUR COPIES; <br />LOT_BLOCK _—OF <br />_ <br />� A 1 Y, Ij a ���I � � J - _ jr - <br />PROJECT ADDRESS r <br />j I(ill� I�Iy <br />APPLICANTS CITY BUSINEst LICENSE O <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />I'EE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE. — <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />- <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />I CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK ISERVICE-BAR, ETC.I <br />WOODSTOVE/FIREPLACE INSERT _ <br />SUB TOTAL <br />SUBTOTAL 3 <br />_ <br />PERMIT S <br />_ <br />_ <br />PERMIT II <br />_ <br />TOTAL FEE 3 <br />TO"AL FEE • <br />-__ <br />BIT DG <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SE IBACK <br />NO OF <br />FEE I RECEIPT NO <br />VACANT SITE FEES VALUATION FEE <br />OYES ONO <br />NO OF DWELLING UNITS <br />I %.PPIIC.TIONACr. BY I PLANTGIECKEDBY I APPR FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PEPALTY <br />TOTAL <br />E <br />