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AI-OLICATION FOR <br />TIM ErvPFNR BYErBR <br />CITY Of CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLEI ED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE -- <br />L' r-v,.rG .I r C,f! /1", "7ki-ic, l 75 3- 7X'C, <br />ARCIIIIECT OR DESIGNER MAN ADDRESS CITY ZIP PTIONE <br />GENERAL CONTRACTOR MAN ADDRESS D.TY 21P PIIONE LICENSEE <br />:I•r,.,.r_ �I(L,Jvvtc 1SJP1L <br />MLCNANICM CONTRACTOR MAIL ADORFAS CITY ZIP PHONE LICENSE <br />PLUMRINGCONIRACTOR MAII AODR^S9 CHY ZIP PHONE LICENSE F <br />CLASS of WORD <br />❑-NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF VICAR ICOST Of MATERIALS PLUS LABOR) rImn <br />y->T..'r'..'`- GOODIES©. . <br />DESCRIBE WORK <br />,• GO.t,4!=7=wcC <br />USE or BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S,I„ /Ti S PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION Of PROPER! 19NUWN BELOW ORARACN FOVR GOPIE9I PROVIS'ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />r P ^ LSACH r(L OF WORK WILL BE COMPLETED VJITHWHETHER SPECIFIED HERE- <br />LoI�_BLOCK _ or IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PP--ERFORMANCE OF CONSTRUCTION. _ <br />SIGNATU(E F CONTRACTOR OR AUTHORIZED AOENLQ' OAIE��•�7-ir� <br />APPLICANr9 CITY BUSINESS LICENSE NO <br />PROJECTTAODRESS <br />p�J / / <br />PLUM NO ___._ <br />_MECHANICAL —_ <br />_ <br />NO. TYPE OF FIXTURE FIEE <br />NO. TYPE OF EQUIPMENT FEE <br />AIR COND. UNITS-H.P. EA <br />WATER CLOSET ITOIlET) ¢ <br />co <br />REFRIGERATION UNITS-H.P. EA <br />BATHTUB _— <br />•� <br />LAVATORYIWASH BAS`, <br />BOILERS-H.P. EA <br />_ <br />OAS FIRED AG UNITS -TONNAGE EA <br />SHOWER <br />_ <br />I <br />_ <br />KITCIICN SINK E DISP. <br />FORCED AlR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />D <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />OD <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />- <br />�- <br />URINAL <br />VENTILATION FAN <br />ItRANGE <br />HDOD <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE - <br />ROOF DRAINS-RAINLEADERS <br />ME7AL FIPEPLACE B CHIMNEY <br />SINK SERVICE -BAR ETC.I <br />WOODS! IVEIFIREPLACE INSERT <br />SUB TOTAL <br />SU_B TOTAL <br />PERMIT <br />PERMIT • <br />E <br />_ <br />TOTALFEE t <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />USE ZONE <br />�_( <br />TYPE Of CONSI <br />V-N <br />Ilj OT Al IU <br />s.r FIRE SPRINKLERS AEG <br />APPLICATION AM BY <br />E-•a <br />BE <br />AREA I VACANT SITE, <br />dlfb. ONO <br />►� <br />I <br />BUILDING <br />MAX DOC. LOAD <br />(0 <br />PLUMBING <br />O <br />MECHANICAL <br />OTHER <br />PENALTY <br />Y <br />APPA FOR ISSUANCE BY <br />— <br />TOTAL <br />Q-f"r/71 <br />L_ G <br />/•` IFEE <br />9 <br />FEE <br />