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TAP EYBrgr9FR ,,PPLICATION FO.. r, <br /> CITY OF CONSTRUCTION <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK--PLEASE PRINT <br /> BUILDING DEPT. <br /> 259.8748 ® COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OW11lR T✓(�.*r. O!�✓h•✓ MAIL ADDRESS �• <br /> Dm c— lipP rNour <br /> F74tr7....r /[....J- J-.6 /14A;ZL✓n..T. F•✓ //f.•Y .;,s T-L/77 <br /> ARCINIROT OF DESIGNER MAIL ADDRESS CITY IIP PHONE <br /> 1M/S('url • - Jir.i 7219 r.�A+,..• Ew ';�.r7:, 3rr-JT7.-.' <br /> OlgIRAI CON,RAf.TOR MAIL AGGRESS CITY DP PHONE LICENSE• <br /> F rNAP�(y.,✓.. AS'v :�.,.. <br /> Is i-//77 PJ.f;I c 14F <br /> MECHANICAL CONTRACIOR MAN AOORE99 CITY ZIP rUONr LCENSF <br /> PLUMSINGCOIITDACTOR MAIL ACOOESS CITY ZIP PHONE LCENRF• <br /> GLL1ASS OF WORK <br /> 1u NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK(cosy DI HAA 11 PUL9 1-1119 LIBOR! <br /> hE-3-'OT,A d• � l0 31 od0.OFJ <br /> BERCRIeF woRK <br /> T L <br /> USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> S"v<Lr v1-. / PLICATION AND KNOWTHE SAMETO BE TRUEANDCORRECT.ALL <br /> LEOiL RF9CRIPDON Or PROPEOTY19110WN 0FLOW OR AT111r,11rOURCOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIEC HERE• <br /> LOT_BLOCS—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �Ji 2AJ CE.7.� ,pry F >•sE ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> PIONATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> l l Z- L G- �^ X ✓<r-� 6 J r <br /> PROJECT ADDRESS APPLI NI'SCITY BUSINESSLICENIE NO <br /> /J 9 77%7, /'L S_v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE_ NO. I TYPE OF EQUIPMENT FEE <br /> WATER CLOSE?(TOILE T) , CL7 AIR COND.UNITS-M.P.EA __ <br /> 1 BATHTUB _ ZLREFRIGERATION UNITS-H.P.EA. <br /> LAVATORY WASH BAST _ BOILERS-M.P.EA <br /> SHOWER OAS FIRED A.C.UNITS-TONNAGE EA <br /> / KITCHEN 81NK A DISP. _ FORCED AIR SYSTEMS-B.T U. M EA <br /> of _DISHWASTER WALL HEATERS-0 T.U. M <br /> LAUNDRY TRAY UNIT HEATERS-B.T.U. M <br /> / CLOTHES WASHER OQ_ EVAPORATIVE COOLERS 7 <br /> _/ WATERHEMER OO CLOTHES DRYERS <br /> URINAL .�S VENTILATION FAN _ <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR GRAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> _ ROOF DRAIN_b-RAINLEADERB METAL FIREPLACE S CHIMNEY <br /> SINK(SERVICE-901,11.ETC. WOODSTOVE/FIREPLACE INBEOr <br /> BUD TOTAL BUB TOTAL t --j V <br /> PERMIT TII PERMIT t <br /> tOTAL F!! t TOTAL FEE t OO <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> ALII[CK 1- <br /> IRON,REIOACK RT.All SI.TRACK SIDE SETBACK PLAN OIRCK NUMBER N /[FfF <br /> '20 -L O G S A/ FEE / RF Ir�.f <br /> USE ZOITE LOTA�ER[�r A/ VV,AlCANT91TE FEES VALUATION FEE <br /> R-I dsimY IL•ES (IND <br /> nrE/Or IS, OCLIIPANCYGROUP NO OF OWE LLINO UNITS <br /> /?1 3 / BUILDING <br /> SIZE Of III HTO IIF"ONES MAX OCC 1 OAO Z <br /> /5 fO S` Z — PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED ❑YES A NO <br /> ' OIIIER <br /> PENALTY <br /> APPIICAtIONACC By I'I ANSf.I1ECALEO By APPil MR ISSUANCE BY <br /> ED TOTAL <br />