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� PPLICATION Fd` EYFFEN <br />1 ITYCF CONSTRUCTION <br />everett PERMIT <br />i TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />i <br />BUILDING DEPT. <br />268•8745 ❑ CQMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />w;;5 3 .5 4:•,?¢orI 1-f it cv4y j .S'3 <br />ARCHITECTOR DESIGNER MAIL AOORESS CITY ZIP / PHONE <br />�yeRPT U/.✓ '7rr0-09/ <br />OFNERAL CONTRACTOR MAIL AL'TSEBS CITY ZIP PHONE I ICENSE F <br />ss►-AtIo, 45 4/�ov J c p% 6 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CA�L"{- OF WON` <br />IT3. NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSE FIT ❑ BUR DING RELOCATION <br />LALUATION OF <br />FFyWOORRyK (COST OF MATERIALS FLUB LABORI <br />•�/Y(7 Gam' _ —__— <br />DEIK:FdBE WORK <br />UBE OF LUILDINO / <br />/oe 4•P fff�%'/ .Y !/('+' <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 />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF PERMIT DOES NOT PRESUME TO <br />NO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. �( <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTYIBHOWN BELOW OR ATTACH FOUR GOPIEM <br />.(� �,'�/vV <br />bLOCKOF <br />P OT ADD ERO BB <br />r' � ra�� ce, <br />APPLICANTS CITY BUSI L ENSNO. <br />PLUMBING <br />MECHANICAL ' <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA <br />REFRIGERATION UNITS—H.P. EA <br />BATHTUB <br />LAVATORY WASH BASIN <br />BOILERS—H.P. EA <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />KIT N SINKS DISP. <br />0 <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />—CH. <br />2ISHWA31­1E14 <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />EL_ THEE WASHER <br />EVAPORATIVE COOLERS <br />WAl ER HEATER <br />IZU <br />1 <br />CLOTHES ORYERS <br />UR'!NAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <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 SERVICE —OAR ETC. <br />WOODSTOV FIREPLACE INSERT <br />_ <br />BUD TOTAL <br />SUB TOTAL t <br />0 <br />PERMIT • <br />PERMIT _ • <br />TOTAL FEE • <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />':�J <br />14NO. OF <br />81 <br />060K 4 l <br />'�A,,\ , I to <br />VACANT BITE <br />EWES ONO <br />NO. OF OW€LLINO <br />MAX OCC LOAD <br />CHECK NUMBER <br />Rr. flG No <br />FEES <br />BURRING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE O)a l 5 I RECEIPT NO <br />VALUATION FEE <br />ZA <br />. . <br />.... Iql. <br />1 <br />