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TAA ELTlprMR ,,PPLICATION FOh. <br />GTY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />259.8745 ❑ COMBINATION ® BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MA'LAoZs CITY DP PIInNL <br />7!.,YGA/ A.Q4/CG a/,zy �L CrS� EE.�B F77 4.r 79any T !r3-7771 L <br />ARCHITLCTOR OE S10NlR MAIL ADDRESS CITY ZIP I410111 -- <br />GENERAL CONTRACTOR MAIL ADDRESS EU{k� fry ILVA, ZIP PHnNE ICENSE• <br />CR -ou•/y <br />C JPO.uiN 7 . S• e. G`u«e� rF Ar/J c�.sy 9 f-3 r'f 3 <i c s'se ,r —/q—t <br />MLLIIAryIUADL CONTRACTOR MAIL ADOnE59 CITYJIP ,,,,,,,,, <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP Pnn NE L111 Nil r <br />�. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDIN3 RELOCATION <br />VAI UATION OF WORK ILOnT O!M ERIALS PLUS LADDg <br />1 J G � ! <br />DLSCOIDL WORK <br />U LCr BUILDING �.—�--" --- <br />'-,e-, 'l /���� A <br />tt -Fr� *-� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AF <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT.AL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPI <br />OF WORK WILL BE COMPLETED Willi WHETHER SPECIFIED HERE <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME T( <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OI <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOI <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGDATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />.GAL�L EscnlPDollor PnOPLnTYISNOWN CLOWORATTACUloURCOIIIES1 <br />LaT2[—DIOLK_or 1��. <br />PROJECT ADDRESS <br />APPtI7ATrscITY BIIRINC SS TIC[ SC 10 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />WATER CLOSET ITOHET) <br />FEE <br />NOT <br />NO. <br />TYPE OF EOUIPMENT <br />AIR CL'D UNITS-11P EA. <br />_FEE <br />1 <br />OATHTUI3 <br />Q� <br />__ <br />UNITS—H. P. EA <br />—3_ <br />LAVATORY IWASII BASINI <br />n_:% <br />BOILERS—H.P. EA <br />SHOWER <br />_ '_GJ <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK 6 DISP. <br />�_ <br />FORCED AIR SYSTEMS—B T.U. M EA <br />_L <br />DISIIWASIIER <br />Lb <br />_ <br />V <br />WALL HEATERS- IT T.U. M_ <br />IAUNDRYTRAY <br />UNIT HEATERS-R T. U. M <br />CLOTHES WASHER <br />_L90 <br />-7- <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />,b <br />1 <br />_WATER HEATER <br />URINAL <br />3 <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />l <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />VACUUM BREAKERS _ <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK iSERVICE=BAR_E n <br />_ <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />_- <br />PERMIT t <br />- <br />--_ <br />PE RM_IT ..�>♦ <br />_ <br />TOTAL FEE t <br />_ <br />_ <br />TOTAL FEE { <br />IT SETBACK <br />!ONE <br />U, <br />.lam <br />Of COry91 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />Inuit SETBACK IsIOE SETBACK ' IPIAIICNrICI K NUMBERPLAN BGEI'TINO <br />LOT ARCA VACANT SITE <br />W <br />/`C. ES ONO FEES VALUATION I iEE <br />I \�JL 111 <br />I )�� h NO or slon¢s <br />IKLERS REOUIRED ❑ YES O <br />ACC BY I PLANSCKECKED BY <br />NO Or DWELLING UNITS <br />I <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />f-Z�Opp�_ 3� <br />