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APPLICATION FOR <br />1'•F"'°'"" CONSTRUCTION <br />an or <br />everett PERMIT <br />FLIILDING DEPARTMENT <br />259-8745 TO DE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION Cl GUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />_ city rip NIONE _ <br />I I,V I�In MAIL AODNC99 355-�03� <br />u� tS�� ►'� 'Dt��S SP��3 3� 5•� _ vE J v <br />MAM1 ADOnf 99 CITYPIIONf <br />I. Nc.T rvID[suwfn _d. �._ A... .�_ _�. ♦L,� IL/ 4cr-LAls1.4, __lL�t.E_il'ArYrl <br />— — _ <br />MAILACDnf95 <br />- Cln <br />ZIP- <br />OINfPALCONDIA^IOR <br />C'IY <br />21P PITON[ l6[MSLE <br />MISIIANICAL CON( PAC100 <br />MAIL ADDRE59 <br />GOy <br />ZIP NIONE LICENSE <br />PLUMING CONIRACTOR <br />MMt ANOnEs9 <br />f• L9501 WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION ZWIIMK CmI Of MAMMALS PLUS LABGn1 y7 —j <br />vtscnml oMK <br />usE of BWlOIMO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AD- <br />'�lll1/i� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND INANCES GOVEFINI NG THIS TYPE <br />PRCPERtY19NOWN0ELOWORAnALNFWRCOPIEN <br />LEGAL 0E4CRIP110N0F <br />OFWORKWILLL BE OMLEEDDWITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PENMIT DOES NOT PRESUME TO <br />t GT_BLOCK__OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />BIONAyII• R;OF CONIMC�Oj105A.I EI ED AGENT GATE <br />APPLICANTSCI /AN 8l'L SENf/ 1 <br />PROJECT ADDRESS LAE <br />-S S • cI <br />MECHANICAL <br />_ <br />- <br />PLUM <br />NO <br />'.YPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENt _ <br />FEE <br />NO. <br />WATER CLOSET(TOILET) <br />AIR CORD. UNITS -HP. EA <br />REFRIGERATION UNITS-d P. EA <br />BATHTUB <br />BASIN <br />BOILERS-H.P. EA <br />LAVATORY(WASH <br />OAS FIRED AG UNITS -TONNAGE EA <br />—T <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. MEA. <br />KITCHEN SINK B DISP. <br />WALL HEATERS-6.T.U. M <br />_ <br />UNIT HEATERS-B.T U. M <br />_ <br />DISHWASHER <br />_ _ <br />LAUNDRY TRAY <br />EVAPORATIVE C10LER9 _ <br />--- <br />_ <br />CLOTHWASHER <br />CLOTH <br />- <br />CLOTHES DRYERS <br />- <br />WATER HEATER <br />VENTILATIETN FAN <br />URINAL <br />RANGE HOOD <br />_ <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />STOVE <br />- <br />VACUUM BREAKERS <br />� <br />METAL FIREPLACE 8 CHIMNEY <br />ROOF DRAI S-RAINLEADERS <br />_ETC <br />EPL <br />WOOD TTOVE/FIRACE INSERT <br />SINK SERVICE-BAN,. <br />• <br />BUD TOTAL <br />SUBTOTAL <br />PERMIT <br />_ <br />_ PERMIT a <br />TOTAL FEE S <br />TOTALFEE E <br />THIS °ORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN CIIECNN MBEO PLANCIIECKFEE <br />IIWNISE104K IREADBEIBAGI{ 610E SEIENACN�— I;i IRECLIPIAl ) ` <br />ME ZONE (LOT APEA I V ES OSITE <br />NO <br />BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S <br />PER <br />