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t..PPLICATION FOklL BYtTBN <br />CITE"R <br />CITY or CONSTRUCTION <br />Oi <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />AACIIITECT OR DESIRNFR MAN ADDRESS CITY JIP rrNnC <br />l)LttL11 s f VA'LttDs LI SLID �Lt Tuae• %tic) C :T'Ct{ lTll 7)` ?''L ?E'Sj- AT) L!1 <br />OcnE"AL cwnnno' U.. <br />A4 /►1?Erl� T'Luc (RA Sbw,`�sli <br />MECHANICAL CONTRACTOR MAIL ADOnESS CITY ZIP PHONE LICENSE. <br />Ne11E <br />PLUMBCO MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />f�L• NE <br />CLASS Of WORK <br />LE7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL. INSERT ❑ BUILDING RELOCATION— <br />�ESCRISF WOnK <br />A-- • A.. AT l__ G.T"F A. Y'A NI IETT//_1- nd r; K 4(. (—i L; wV v4# NOVA <br />usE Or nunnU'G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND 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 />qI E AUTHORITY TO VI TE OR CANCEL THE PROVISIONS OF <br />AN OTHER STATC-O CAL LAW REGULATING CONSTRUCTION <br />O E PERFORMA CE OF CONSTRUCTION. <br />SIO JAR IE OF CONTRACT In On AUT14ORIZED AGENT DATE <br />x A >i.,��z��i� �( <br />LEGAL DESCnIPTIUNOF PROPERTY ISNOWN "FLOW OR AT TACH OUn COMEu, <br />�•�E/7'� 1 <br />LOT �RLOUC�—Oi hT' I IL (� T �I' 1° t <br />�YL•L•.. �El��;t.ff• <br />PROJECT ADDRESS I .�11 t <br />Air l l 7� U silly �1 uld <br />PLUMBINO <br />APP SCI TV BUSINE BSI EN9 NO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />No.7 <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H P. EA <br />— <br />REFRIGERATION UNITS—H.P. EA <br />_BATHTUB <br />LAVATORY WASH BASIN) <br />BOILERS—M.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEA-ERS-0.7.U. M <br />_ <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />I 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 />ROOF DRAINS—RAINLEADERB <br />METAL FIREPLACE S CHIMNEY <br />SINK SERVICE —BAR ETC.I <br />WOODSTOVE/FIREPLACE INSERT <br />BUD TOTAL <br />BUS TOTAL t <br />PERMIT t <br />PERMIT t <br />TOTALFEE t <br />TOTALFEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAn SETBACK SIDE BE (BACK PL AN C,N/fCKNUMBER ^LAN CHECK FEE <br />C!/ el. `/' IRECEIPINS <br />USE ZONE �LUt ARFA SIZE <br />E/._ l� nYES OYES ONO <br />TYPE �UT CONS( OCCUPANCY GROUP I NO OF DWELUNGUNUB <br />OE BI DO I NO OF STORIES I MAX OCC LOAD <br />ACC BY I PLANS CHECKED BY I APPR Ton ISSUANCE BY <br />:7 I AT, <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />