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-''APPLICATION FOR <br />the °'"" On OF CONSTRUCTION <br />Dm or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />I F GAAnI ItInM n rnMRINATION O BUILDING i(MECHANICAL <br />❑ PLUMBING <br />e ereR <br />L <br />❑ SIGN <br />NIONI LICENSE <br />UENERAL CONTRACTOn MAIL ADDFIF B" "'^ /� [��/_�� �' <br />IILu c� sue, <br />LICENSE <br />C <br />C,L.A/y+OF V/ORX <br />DO NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERi ❑ BUILDING RELOCATION <br />VALUATIONOF WORB(C ST Of MATERIALS PLUB LABOR, <br />J7( ) / n[70 �. � / <br />DESCRIBE W4I RK , 1 / . i 1) / / L /, <br />/ <br />_--- <br />USE or 0.1,10 <br />C7 <br />1 REBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />ALL <br />iil' �a r' r cT Li (T <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />ROPERIY IBNOWN BELOW OR AITACI..OUR LOPI[el <br />LEGAL DESCRIPTION <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />NOR NOT, THE GRANTING PERMITOF A PRESUME <br />LOT— BLOCK OF <br />GIVETTE OR CANCEL THE PROVISIONS OF <br />UTTHOR TYY TO VIO <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />S DNATURE OF CONTRACTOR OR AUD40RIZED AGENT DALE <br />X <br />APPLI A <br />TS CITY BUSINESS LICENSE NO <br />PROJECT <br />ADDRESS <br />(o v <br />PLUM <br />NO ____ <br />TYPE OF FIXTURE <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />TEE <br />_ <br />NO. <br />WATER CLOSET (TOILED <br />IAIR <br />COND. UNITS-N.P EA. <br />_ <br />REFRIGERATION UNITS-H.P. EA. <br />BATHTUB <br />LAVATORY WASH BASIN) <br />BOILERS-H.P. EA. <br />OAS FIRED AC. UNITS -TONNAGE EA <br />SHOWER <br />AIR SYSTEMS-B.T.U. M EA. <br />KITCHEN SINK A DISP <br />_FORCED <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-D.T. U. M <br />_ <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER IIEATER <br />CLOTHES DRYERS ' <br />URINAL <br />_ <br />_ <br />VENTILAIION FAN y' Off- <br />DRINKING FOUNTAIN <br />/V <br />RANGE HOOD <br />AIR HANDLING UNIT- C F.M. <br />_ <br />FLOOR DRAIN <br />VACUUM DREAKERS <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />_ <br />ROOF DRAINS-RAINLEADERS L <br />WOODSTOVE/FIREPLACE INSERT <br />SINKISERVICE-BAR ETC) I) <br />�C <br />SUBTOTAL <br />SUBTOTAL <br />PERMIT S <br />PERMIT A <br />TOTAL FEE S <br />TA <br />TOTAL FEE A <br />n O <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL,(/' "_LV <br />i <br />