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t <br />APPLICATION FOR PYBFlN <br />the CiryOF CONSTRUCTION CITY OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ CON BINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN_ <br />__ .. UOT SP PHONE <br />PLUMBING CONTRACTOR MAIL ADO LESS COY FIT, PHONE LICENSE• <br />d P. ROmfS11JC� IiSa,' PiC iir ' ion I �fJ33 <br />CLASS OF WORK <br />19 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL INSERT ❑ BUILDING R1c -7 TI V <br />00 <br />IESCRIBE WORK <br />USE OF BUILDING . 1 <br />I HEREBY CERTIFY THAT I HAVE READ AND FXAMINED THIS AP- <br />ANDCORRCCT. ALL <br />PLICATION AND KNOWTHI: SAME TO BE TRUE <br />TIC; 1-Tq <br />PROFFRTTISHOWN DE LOW OR AITACNFOua COP-ESI <br />PROVISIONSrIr I AWS ANTI r)RDINANCrrnL'rnNnP; <br />LEGAL OESCRIP ION OF <br />nr L'rc n <br />LiIVE AUIIIUHII F IU VIOLATE OR CANI.LI IhIL.'HU✓I <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI lul I <br />OR TH PERFORMANCE OF CONSTRUCTION. r <br />sIGNATI I or CONNIACIOR On AUHIORI7UO Af HT DAIE�ii/�J <br />X <br />APPl1 ANI CITYBUSINF.SS LICE NSF NO <br />PROJECT <br />qz <br />ADDRESS <br />1 �a-' STF <br />MECHANICAL _ -- <br />PLUM <br />NO <br />NO. TYPE OF EQUIPMENT __FEE <br />FEE <br />N0. <br />TYPE Of FIXTURE <br />� <br />AIR COND. UNITS-M.P_I:A. — <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS-•H.P.EAA <br />_ <br />BATHTUB <br />_ <br />D <br />BOILERS -HP. EA. <br />LAVATORY WASH BASIN( <br />_ <br />OAS FIRED AC ,WITS -TONNAGE EA <br />SHOWER <br />SHOWKITCHER <br />FORCED AIR SYSTEMS- B,T_U. M EA <br />SINK 6 DISP. <br />_ <br />,__ <br />WALL HEATERS-B. T. U. M <br />_ <br />/ <br />DISHWASHER <br />UNIT HEATERS-B.i.U. M <br />/ <br />LAUNDRY TRAY <br />EVAPORATIVE COOLENS <br />CLOTHES WASHER <br />�_ <br />20- <br />/ <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />jwL <br />URINAL _ <br />RANGE HOODLING <br />-� <br />DRINKING FOUNTAIN <br />AIR HANDUNIT- C.F.M. <br />-' <br />FLOOR DRAIN <br />STOVE <br />BREAKERS <br />VACUUM BREAKERS <br />METAL FIREPLACE B CHIMNEY <br />ROOF DRAINS RAIEAOERB <br />WOODSTOVE/FIREPLACE INSERT <br />SINK SERVICE -BAR ETC. <br />BUB TOTAL <br />SUBTOTAL <br />PERMIT S <br />PERMIT f <br />_ <br />_ <br />___ <br />TOTAL FE S <br />E <br />TOTAL FEE f <br />__ _ <br />_._. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN CHECK FEE <br />RE-'n SSETTBBAACCKy BIDE B'ETwBACeY PLAN CHECK e1J/M/tlI'R7 FE 'rf' RE�FIPTNO <br />Zt.• LOT AREA YACA!J1 SITE FEES �✓3''A 1IDM _ FE[ <br />0 <br />FO rONBT <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITE <br />BUILDING <br />V• N <br />K 3 F lI� <br />EOi IDO <br />NO. OF STORIES <br />MAX OCC LOAD <br />1I�4 <br />I <br />5 <br />PLUMBING <br />MECHANICAL <br />IE SPRINKLERS REOUIRED O YES Gf NO <br />OTHER <br />PE NALIY <br />'LIGATION ACC BY <br />PLANS OITECKEO BY <br />APPR FOR ISSUANCE BY <br />_ <br />L <br />TOTAL <br />f <br />z <br />O <br />--I <br />P-I <br />n <br />m <br />