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IRE E"'animn iPPLICATION FO.O. EVEFER <br />Cm OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />/ice 1LAA'/1 UAD/Jell l v// 73 S% L I/ /r6Tl 7 � 703 Ss-�3 G <br />ARCHITECT OR E Obfn MAIL ADOnESB CITY ZIP PHONE. <br />GENERAL CONTRACTOR MAIL ADD"[ 89 CITY ZIP PImNE LICENSE E <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP POONE LICENEL• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 1p' WOODSTOVE/F RPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OE WOnK ICOST OE MATERIALS MOB LABORI <br />1 / s v, <br />DESCRIBE WORK <br />USE ofBUHLOINO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X l�2✓Ti�I <br />LEGAL DE9CIOPTION OF PROPERTYISHOWN DELOWOR ATTACH FOURCOPIE81 <br />LOT_RLOCK_-OF <br />opt e J BLOO <br />PROJECTADDRESS <br />3 J <br />APPL ANTSCITYBGSINESSLICFN9 O <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS—H. P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORYIWASH BASINJ <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS—TONNAOE EA <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL "EATERS-8 T.U. M <br />LAUNDRYTRAY <br />_ <br />_ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WAIE'1 HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINOING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />SIOVE <br />ROOF DRAINS—RAINLEAUERS <br />METAL FIREPLACE B CHIMNEY <br />_ <br />SINK SERVICE —BAR. ETC.) <br />WOODSTOVE.-'REPLACE INSERT <br />SUBTOTAL . <br />PERMIT i <br />BUD TOTAL <br />PERMIT S <br />TOTAL FEE • <br />TOTALFEE 9 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />NO DO STORIES <br />CHECKED BY <br />VACANT SITE FEES <br />DYES ONO <br />NO OF DWELLING UNITS <br />MAX OCC. LOAD <br />FOB ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />1 <br />RECEIPT NO <br />FEE <br />