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APPLICATION FOR <br />CITECONSTRUCTION <br />OF <br />CITYOF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />4�:ArAA.Je Sljl>vAav4?z fF.! <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE UCFNSE0 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 20' PHONE LILFNSI A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MA I EAIAL S PLUS LABOBI <br />-IVSi M&A- 215 Gti]U <br />USE OF Bi ILOIHG <br />t/Fn�eL <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AI 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 />ANYOTHER ATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERF)RMANCE OF CONSTRUCTION. <br />SIGN AT nF. OF .O 1RACTOA I�n11�1\10`AIZED AGENT �I%UffFF_ <br />LEGAL DESCnIPT10N0 PRO ERTv(SHOWN BELOW OR ATTACH FOUR COPIES <br />PROJECT ADDRESS <br />�5tW � <br />�'�}JCAN . UTY AlKNFSS LICENSE NO <br />PLUMBING E <br />MECHANICAL <br />_1407 <br />IN <br />TYPE OF FIXTURE <br />FEE <br />TYPE OF EQUIPMENT <br />FEE _ <br />WATER CLOSET .TOILET) <br />ICYl <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY WASH BASIN <br />T <br />_ <br />BOILERS-H. P. EA <br />SHOWER <br />OAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-8 I . M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-87 U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F.M <br />VACUUM BREAKERS <br />_ <br />_ <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />_ <br />METAL FIREPLACE & CHIMNEY <br />SINK SE VICE-BAR,ETC.1 <br />WOODSTOVEIFIREPLA:E INSERT <br />SUB TOTAL <br />BUD <br />PERMIT { <br />PERMIT t <br />TOTAL FkE / <br />tal <br />TOTALFEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNE?L <br />N/d I ,L116 I "P <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />A4 -M <br />DYES BRTS <br />"RE OF CONST <br />OCCUPANCY OR" <br />NO OF DWELLING UNIIS <br />V_Iwrz <br />134 <br />kA <br />SIZE OF BLDO <br />NO OF STORIES <br />MAX OCC LOAD <br />12/2Cao 5. F, <br />I <br />12 3 - <br />By <br />STJ <br />1-�W )) <br />APPR FORISSUAN <br />L . c- <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEES <br />'L n[r/O'Q 1 <br />VALUATION I FEE <br />E <br />MEr-r-i . pE c v-- <br />z <br />O <br />--1 <br />n <br />m <br />c <br />c' <br />m <br />