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h7 h7 � <br />AD b H <br />IN Enromn <br />Cm OP <br />everett <br />BUILDING DEPT. <br />559.8745 <br />APPLICATION FOR !Y� <br />CONSTRUCTION <br />PERMIT <br />I J BE L;OMPLETED IN BLACK INK— PLEAiE PRINT <br />® COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />L /C UM // "9FH ICE <br />• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CUBS OF WORK <br />10 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINBERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK(COSI OF MATERIALS PLUS LABOR) en� nwM OD <br />t4( T <br />UJE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />HERE- <br />INEOR NOWORKT. THEE ANTINOOFA PERMIT DOES NOTPRESUMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY JTHER STATE OR LOCAL LAW REGI".ATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUI ION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AuE IT DATE <br />PROJECT ADDRESS <br />L"P <br />CITYB NE U EN NO <br />tqcp S < <br />_&5 <br />MECHANICAL <br />PLUMBING <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIRTURE <br />FEEVAS" <br />D. UNITS-H.P. EABATHTUB <br />WATER CLOSET TOILE <br />RATION UNITS-N.P. EALAVATORY <br />S-H.P. EASHOWER <br />WASH BASI <br />ED AC UNITS -TONNAGE EA <br />AIR SYSTEMS-BT,U. MEADISHWASHER <br />KITCHENSINKS DIBP. <br />EATERS-B.T.U. MLAUNDRY <br />ATERS-BT.0 MCLOTHESWASHER <br />TRAY <br />ATIVE COOLERSWATER <br />SDRYERS <br />— <br />HEATER <br />- <br />Z <br />VENTILATION FAN <br />_ <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />_ _ <br />AIR HATIDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />STOVE E.1 <br />VACUUM BREAKERS <br />METAL FIREPLACE S�NEY <br />ROOF DRAINS-RAINLEADERS <br />WOODSTOVEIFIREP <br />SINK SERVICE -SA ETC. <br />I <br />BUS TOTAL • <br />SUBTOTAL <br />PERMIT • <br />- <br />PERMIT • <br />TOTAL FEE • <br />= <br />- <br />TOTALFEE E <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PER50NNF-L <br />//SOo ,i <br />JSE ZQQN��E <br />rJ� I <br />LOT ANEA <br />VACRyT SITE <br />Q'TF6 ONO <br />TYPE OFFFCCORSI <br />�- tj <br />OCCUPANCY GROUP <br />� / I� <br />NO OF DWELLING UNITS <br />" I <br />BILLDING <br />SIZE Oic ljl s r NO. OF BTO�EB MAX OCL LOAD <br />Z r AI 8 <br />s. <br />' � <br />FIRE SPRINKLERS REOUIRED O YES YNO <br />FLUMBIN6 <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />E •g <br />PLANS CHECKED BY <br />t.�wm <br />APPR FOR 155UARCE BY <br />TOTAL <br />:J <br />