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THE P+�7nPn <br />APPLICATION FGa <br />•�YEEEI, <br />.ITYcr <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />III ADDRESS CITY ZIP <br />PHONE. <br />CIM1 ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />M•LADDRESS <br />GENERAL CONTR ICTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />I,,'NSF• <br />\-1 Dn/1,1 'wQli'JLI <br />/ I S .S •F •v..dd P4# .,;rz rtic, Mi.j S' ZL'Mi <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CIM1 71P <br />PIgNF <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PPOINE <br />LICENSE• <br />CUSS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/fRPL.INSERT ❑ BUILDING RELOCATION <br />a 6s ODU (�1�1 <br />DI stoles w�— <br />USE OF BUII DING <br />LEGAL1 DDMAIPTION OFF V9DPEPV AHnWN PIIOW OR AT ACH FOUR COPIER <br />LOT-I�mmi;-5-i�-.--ok 1. L.._T <br />I HEREBY CF.PTIFY THAT I HAVE. READ AND FY.AMINED THIS AP- <br />PLICATION ANU KNOW THFSAMF TO RE TRUE AND CURRF C T ALL <br />i:. )141401. I PIL UIIAII I INU OF A F'LHIAI I UULS 1NU I I'1 d_ . <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS UI <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. L� <br />SIGNATURE OF CONE RK:TOR OR AUTHORIZED AGENT DATE <br />X 1J� "i Ge %�� Z <br />PROJECT ADDRESS <br />7003 114 ALA c.f. h D-Oy <br />APPLICA FSCVR USINESS LICENSE NO <br />PLUMBING __ <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF FIXTURE <br />I'EE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILER <br />;VToo <br />AIR COND UNITS—H. P. EA <br />BATHTUB <br />20 <br />REFRIGERATION UNITS-H.P. EA. <br />l <br />LAVATORY WASH BASIN) <br />0 d <br />BOILERS-H.P. EA <br />SHOWER <br />00 <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_! <br />KITCHEN SINK DISP. <br />_ <br />d O <br />FORCED AIR SYSTEMS-B.T.U. MEAL <br />J <br />L`ISHWASHER <br />OD <br />WALL HEATERS-&T.U. M <br />__ <br />.T.U. M <br />_ I <br />! <br />CLOTHES WASHER <br />WATER HEATER <br />v <br />A7 <br />I <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />-� <br />URINAL <br />S <br />VENTILATION FAN <br />00 <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE a CHIMNEY <br />SINK SERVICE -BAR ETC.I <br />WOODSTOVE/FIAEPLACE INSERT <br />SUB TOTAL <br />d <br />SUBTOTAL • <br />O <br />PERMIT • <br />_ PERMIT • <br />TOTAL FEE • <br />_ 0 <br />0 <br />TOTAL FEE _ • <br />THIS PORTION TO BE COMPLETED BY BUILDING I)EPT. PE � ONNEL���, �; <br />.d 12 <br />REAR BE� R / <br />p� d <br />•N rIT SITE <br />CIE/- �.M; lN0 <br />FCONIT OCCUPANCYGROLP - 1w OF OWELI <br />-�J R3JM I <br />FIRE SPRINKLERS REQUIRED DYES LR'NO <br />PUNS CHEF AD BY <br />glum <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHE R! <br />PENALTY <br />TOTAL <br />� n <br />/ <br />FECF�FF`I/ PEOEIPTNO <br />VALUATION INTO <br />EAAg 00 <br />.20 00 <br />Od <br />�G 3 OC <br />