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IA. EINFORMR O:PPLICATION FO"' <br />CITY OF CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259•8746 ❑ COMBINATION ❑ BUILDING X MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />L n,A �ML,AIIL ADDRESS <br />) CITY ZIP PHONE <br />4A /�D�1► (f1 Cl1 , � ' //,�U tf .(Ve. �,/ stiff/P <br />LICENSE <br />Q 0T Iec U ezf. J <br />MECHANICAL CO ACTOR "U'lZRE49 CITY b PHONE LICENSE • <br />�?"�c�,l•1h�� , r' �s�- �.,^�avf/� �i. st�iog 7L� 33//k/ter t>l i7rt�v <br />.enuruA[iFwI MAIL ADDRESS LILY ZIP PHONE LICENSE• <br />�OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />TION OF WORN ICOST OF MATERIALS PLUS LABORI <br />DESCRIBE WORK 1 / t <br />en{1 /iJ.�w i j Ji/4�.aA'1 <br />USE OF BUILDING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF ONZCTOR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK__GF <br />f CIS <br />PROLE lA0pRE55 <br />- 7s SSE S. <br />APPUCANrs CITY BUSINE59L NSE NO <br />�G 8/ - w <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSETITOILE <br />AIR COND. UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY WASH BASIN) <br />BOILERS-/1 P. EA, <br />SHOWER <br />OAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATER"T.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- OF.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE CHIMNEY <br />SINK SERVICE -BAR. ETC. <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT B <br />PERMIT B <br />TOTAL FEE B <br />TOTAL FEE 6 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />