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APPLICATION FOR <br />Pr�l <br />1; <br />CONSTRUCTION <br />0 <br />CITY of <br />OF'"" <br />everett <br />PERMIT <br />TO BE COMPLEIED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />� COOMBINATION,,/ ❑L BUILDING ❑MECHANICAL ❑ <br />PLUMBING <br />❑'7SSIIGN <br />\ <br />Y (/ <br />NER. 'J <br />MAII��OEB L <br />I1) t +\ IRIS ZD� zi <br />U <br />�07� /'-76 61 <br />t/• <br />A CNITEC DR DESIGNER <br />\r��I Y/aJ� <br />MAIL ADDRESS Cl/Y . IP <br />PHONE <br />CONTRACTOR <br />GENERAL CONTRA <br />M 1IL A OORE95 CITY .IP <br />PIIONE <br />/I ��ys <br />IM;ENBEA <br />�ti 3N19 <br />MECHANIOALCONIAACTOR <br />MAIL ADORERS CITY 21P <br />PHONE <br />IICENSE <br />PIUMBINGCONIDACTOR <br />MAIL AUVRE35 CITY ZIP <br />PNONE <br />LICENSE <br />CLASS OF WORK <br />VANE of ❑KADD.I OIFOMAIERI❑AlB PLUSRBTORI2 l❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT 0 BUILDING RELOCATION <br />DESC IB' WORK <br />UBE OF euILDINo <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP* <br />�� <br />PLICATION AND KNOWTHE SAME TOBETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEOAL Qp SCRP1NN Of PROPERTYIS110WN BELOW OR AT1ACH row CIIPIEN <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE - <br />C(/+ <br />IN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />BLOCK OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />n n <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTRACTOR OR AUI�IHH11ORIZE 0 TT DATE / <br />1 <br />APPLI 'BCIIY BUSINESS LICENSE NO. <br />PROJECT ADDRESS / � <br />/,,. <br />f� <br />MECHANICAL <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />PLUM <br />NO . <br />NO. <br />TYPE OF FIXTURE <br />AIR COND. UNITS-M.P. EA <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS-M.P. EA <br />/- <br />BATHTUB <br />BOILERS-H.P. EA <br />LAVATORY WASH BASIN <br />GAS FIRED AC. UNITS -TONNAGE EA <br />— <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />KITCHEN SINKS DISP. <br />WALL HEATERR—B.T.U. M <br />J. <br />DISHWASHER <br />_ <br />U <br />UNIT HEATERS—&i.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />OD <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER NEATER <br />VENTILATION FAN <br />— <br />URINAL <br />RANGE HOOD <br />— <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C.F.M. _ <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL EB CHIMNEY <br />ROOF DRAINS—RAINLEADERS <br />IREPUCE INSEITI <br />WOODSTOVE/OVE/FIR <br />SINK SERVICE —BA ETC. - <br />SUB TOTAL • <br />eS <br />SUBTOTAL <br />- <br />PERMIT <br />' <br />PERMIT f <br />_ <br />TOTALFEE B <br />55 <br />TOTAL FEE � <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />EEEz. / PJAN CHECK <br />RECEI <br />PEAR SETBACK BIDE SETBACK PLAN CHECK UMBERFj <br />cvF"7 2 OF7 /3 9 <br />LOT AREA VACANT SITE FEES VALUATION <br />/ <br />L11E6 ONO <br />YPE OF CON-SIr <br />OCCUPANCYT GROUP <br />NO. Of DWELLING UNITS <br />_ <br />BUILDING <br />1; OSB 10' S. T' NO. Of BIORIEB MAK OCC. LOAD <br />'1 <br />PLUMBING <br />w 4. I <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED O YES LLYNO <br />OTHER <br />PENAI TY <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />APPR FOR ISSUANCE BY -- <br />TOTAL <br />S <br />f6 ?Jr <br />FEE I <br />,A e i <br />o cv <br />-I1 <br />