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IM EYErpnM IPIPPLICATION FW <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT <br />259.8745 ❑ COMBINATION ©'BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITr <br />ZIP <br />PHONE <br />,j E C:.IA// EVf.Ie <br />ES'b'n.� <br />'04 K 4-2o3 <br />�� fs•-3..,'''�3 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CuCRC tf 6v'j• <br />t? 0" 1/ <br />UENEDAIL CONTRACTOR <br />MAIL ADDRESS <br />CNV <br />ZIP <br />PHONE LICENSE IF <br />c� C rlsrz7A, N�.LIeS <br />• 7/7 <br />, <br />S. cI Cve-0 e -if /EyTI <br />«'Q�' <br />?53, scv <br />,Qi�1�r• <br />MECHANICAL CONTRACTOR <br />MAIL ADORERS <br />OITY <br />ZIP <br />PHONE LICENSE IF <br />,- f v,v„ ,ea/s/ 'o <br />MUMBINOCONTRACton <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE - <br />CI. ASS OF WORK <br />EYNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />0 <br />[If 3(.HIUf WUI R � <br />USE OF OUR 01N0 <br />LOI/ / BLOCK or <br />m <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO SE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED IIERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PRO.ECT ADDRESS <br />/(,) e?/SSTN G. a.&, <br />AI'PIICANTB CITY BUSINEB CILENSE NO. <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE <br />FEE_ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILET <br />C!Q <br />AIR COND. UNITS-H.P. EA <br />I <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY IWASH BASIN) <br />_ <br />Eb <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK t DISP. <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />OCT <br />WALL HEATERS-B.T.U. M <br />I <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />—�) <br />'!i <br />_ <br />UNIT HEATERS-B.T.U. M <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />O <br />CLOTHES DRYERS <br />Z�. <br />% <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />STOVE <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />erm <br />BUS TOTAL • <br />PERMIT t <br />_ <br />PERMIT <br />TOTAL FEE S <br />TOTAL FEE t <br />THIS PORTION TO Est COMPLETED BY BUILDING DEPT. PERSONNEL <br />I IIONT SE (PACK <br />NEAFl q(I0ACK <br />O <br />USEUSElDII� <br />A <br />LOT AI A <br />o496 c <br />I YI11 1a)ll 1 . <br />611 <br />SVE DI BI IIO <br />NOW STORIES <br />If �1 fe7o M <br />1 <br />UIORACC BY I <br />PIANSCHECKEDI <br />\r� Jf4r- <br />VACANT IfE <br />rifS ONO <br />AA <br />NO. OF 07ELLINO UNITS <br />BUILDING <br />MAIL N 0fL1 OAD <br />PLUMBING <br />O <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPn FOR ISSUANCE BY <br />L. G <br />TOTAL <br />Spa?er'V3. ?o nna Irl ND <br />I 77oq <br />FEES VALUATION FEE <br />