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riAPPLICATION FOItr <br />evcrett <br />the EYergroen <br />CITY OF <br />CITY <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ <br />COMBINATION ❑ BUILDIN 3 ®, MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />afrlvn r <br />92B G/ 1,14"gf Ii'P /,q. C-ve, 95'z?I/ <br />•I�S� F <br />ARCHITECT On DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOn <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />CA�J(w C0ASi <br />yL <br />e.g. r7Dx 1291 Eve ' %f'z01 <br />-2S9.3b67 <br />C0-6R•AC-C '(1c <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />J <br />/.JP/'�/P(n S'IA�P J1Ytt/ IAIi <br />�] <br />�A� 1". P0. 6PY lype <br />- <br />PLUMBII'CONinACiOR <br />1 MAILADDRESS CITY ZIP <br />PITON[ <br />LICENSE• <br />CLASS OF WORK <br />a NEW ❑ ADDITION ❑ <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING <br />RELOCATION <br />VALUATION WOnKICOstor MATERIALS PLUS LABORI <br />nOOF <br />$ <br />/1PPx /I OFy <br />DESCRIBEw R <br />IJ Ti /I A/ <br />J; <br />JT• <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TIME SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ��E-LCc u` N7 u— <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES, <br />LOT— BLOCK —_OF <br />PRUJCCTADDRESS <br />APPLICANT ITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FES <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P-EA. 3 t 3 116. TO <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 />Z <br />FORCED AIR SYSTEMS-B.T.U. M EA, 10 PFF 0 <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />— <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE. 3 CHIMNEY <br />_ <br />SINK(SERVICE-BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT S <br />_ <br />TOTALFEE $ <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT BE TBACK <br />OCCUPANCY GROUP <br />SIZE OF BLDG. <br />APPLICATION ACC. BY <br />S/d <br />VACANT SITE <br />OYES ONO <br />MAX. OCC. LOAD <br />FOR ISSUANCE BY <br />FEE RECEIPT NO. <br />FEES VALUATION FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />