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APPLICATION FOL !YlTEH <br />the I� °"" CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. 1�,F <br />259.8745 ❑ COMBINATION IW BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />WYNER MAIL ADDRESS CITY ZIP PHONE <br />/1C/JLTY/3�/,�oF/1drTMA 1414Y Fd/rh��% 9BZol� 3µ8-363: <br />ARCHITECT OR DESIGNER MA ADDRESS CITY z ZIP PHONE <br />O[NFRAL CONTRACTOR MAIL ADOREeS CITY ZIP PHONE LICENSEE <br />T�TY �a /�T¢✓c�a��/s/licr��—�riE2,se44.,4.t�,�r:��. 7�f3-�sy8 <br />MECHANICALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />%v(y4G Z32oj <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />CUSS OF WORK <br />10 NEW ❑ ADDITION ❑ ALTERATION ❑ REf '� DEMOLITION ❑ WOOOSTOVE/FRPI.. INSERT ❑ BUILDING RELOCATION <br />VALUATI Or WORK ICOST or %ATERIALS PLUS LABOM <br />�•�765u <br />OFSCRIBE WOR <br />NEW CAI U[ Owl <br />w <br />II <br />'I <br />uaT or ewl ING <br />4T/A✓G4GC 64,44/Gj� A�S/����� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT. ALI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPI <br />OFWORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TL <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OI <br />ANY OTHER STATE OR LOCAL LAW REGULATING CON3TRUG�� <br />OR THE PERFORMANCE OF CONSTRUCTION. //pQ�/ <br />SXIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE , <br />L.I4f4(", <br />LEGAL DESCRIPTION ��OFFC`PROPEAIYIBHOWN BELOW OR ATTACH POUR CnPIESI <br />Lor eLocl�oE �� / Si J'S/Or/ _ <br />/ S-r 0 rT <br />/^� <br />at-- lo r- /� �3 O L�f' R - <br />8�7/ D/a. L , _ VK 8 P35. <br />PROJECT <br />03/0-�,tci ,Cd.*.¢E?%W.I. 93003 <br />APPLICANTeC HOf <br />07 <br />MECHANICAL <br />NO. I I F EQUIPMENT FEF. <br />AIRCOND. UNI TS-H. P. EA. <br />REFRIGERATION UNITS-HF. EA <br />BOILERS-H.P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />WALL HEATERS-B.T.U. A110 jj� <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />72 <br />WATER CLOSET TOILE <br />FEE <br />BATHTUB <br />Z <br />LAVATORY WASH BASIN <br />f <br />SHOWER <br />Z D <br />_/ <br />KITCHEN SINK A DtSP. <br />DISHWASHER <br />CV <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHESWASHER RIr <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERSyFzl <br />URINAL <br />URINKING FOUNTAIN <br />VENTILATION FAN <br />RANGE HOOD <br />a <br />FLOOR DRAIN <br />AIR HANDLING UNIT- .K M. qr,5jCd, <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPLACE INSERT _ <br />SUBTOTAL <br />cJ <br />SUBTOTAL A <br />_ _PERMIT A <br />TOTALFEE A <br />S <br />TER <br />PERMIT A <br />TOTAL FEE A <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />BEAR SETBACK SIDE SETBACK PLAN CHECK NUMSE01 PLAN CHECK FEE <br />Zo/�71 60 f FEE //IQ7 RECEIPT NO 8/�! <br />TOT AREA yACAJ1T SITE 10 w/ <br />OYEJ ONO FEIS VAlUAT10N FEE <br />:ONS <br />- A <br />APPLICAIIONACC BY <br />ut <br />3 <br />PLANS CHECKED BY APPR FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />Vi <br />