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TMEregrEen ,—APPLICATION Full rvrrrll <br />CITY Or CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 O�COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />IWMlR MAIL AODRESS CITY ZIP PHONE <br />J'1Rv�IrS /y'urr i Jf,.T 7d'e Y,z Al_� S!, /rL!/ 4�'sb• yA•RC� 35-5's9y� <br />ARCHIIECr OR DESIGNER MAN ADDRESS CITY LIP PIIUNE <br />HINT NAL CONTRACTOR MAIL ADDRESS CITY zip PHONE LICENSE E <br />" / .-.:.,: 1 r-C��r�j/p•R _ `7.>?/C /r,.t.ITC•i'6.F_�l �A'*-� �E;cr/7 yf.tc�/ •35,�-77LCT cJCCNAI�Y/9i� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CRY SIP PHONE LICENSE E <br />PI UMOINO CONTRACT11 MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CG ASS Or WORK / <br />❑ NEW •❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OEMOLITION ❑ WOOOSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WDRK ICOST qP MATERIALS PLUS LABOR) <br />!Cy' <br />S D,'c' <br />Df !{CRIBE IN K <br />A J J O/A, . n 7a ?..�.,... <br />USE Or BUILDING <br />!,1 S <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTI NG OF A PE RM IT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. / /: _ <br />SI NATURE OF CONTRACTOR OR AUI OflIZEDfOENT DATE �� d/S <br />X�Q.e �IA W <br />T <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH rUUB COPNSI <br />/n.` V/ ��✓ <br />IGE.�I_RLocr_oF rl�'Ae•�•sJw' <br />PROJECT ADDRESS <br />yI-•r y-z-s,? s, jr <br />APPLICANTS CITY BUWNE55 LICENSE NO <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />PER <br />WATER CLOSET TOILE <br />AIR COND. UNITS—H. P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK S OISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WABIEER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />BREAKERS <br />STOVE <br />_VACUUM <br />ROOF DRAINS—RAINLE_AOERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK ISERVICE—SAR, ETC.1 <br />WOODSTO FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL B <br />— <br />_ <br />PERMIT • <br />PERMIT S <br />___ <br />TOTALFEE S <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />-AIRRACK <br />REAR St TSACK <br />W <br />St <br />W <br />)Nr <br />LOT AIR A <br />IT / <br />/E.i left <br />I RPIT <br />�" • N <br />OCCUPANCY CROUP <br />R� s <br />E pl p0 <br />NO Or 'TORTES <br />SPRINKLERS REQUIRED U YES W <br />:ARCH, AM BY I PLANS CHECKED BY <br />IiTp:� I ✓6r- <br />SIDE BE TBACK <br />VACANT SITE <br />DYES ITEID <br />L.0 <br />NUMBER (� PLANCIIECKFEE <br />/ 7 P?� FEE S.2 F 3 RECEIP NDg <br />FEEL I VALUATION FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />