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IR. ErEr•n•R APPLICATION FOR <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMF:Nf <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION O'COMBINATION O BUILDING O MECHANICAL <br />U PLUMBING <br />PT rrrlt <br />❑ SIGN <br />•I <br />nL'nE11PPEC4 AI•CfO-�NrReC On <br />CIIY <br />ZIP 11111,11 <br />[IC[NBE��� <br />l�"'cam <br />pMA�IL�AOOnEIB•••�+'�.�y,.v.. <br />L]nvfE'......_... <br />'" <br />..v ...... <br />MECN NN:AL CONIIIACTOR <br />MAIL AODOESS CITY <br />ZIP PHONE <br />EINAR r <br />PLUMBING COrTTRACTOn <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />LICENSEE <br />CLASS Or wonK <br />B'F1EW ❑ ADDITION ❑ <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ <br />BUILDING RELOCATION <br />n[BcmnE <br />Gp LJ-�i�T <br />uEE Or BlnlnlbR �' r� <br />I--�aI.ILY <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECf.ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WI IETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <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 />SIONATUBE Or CONTRACTOO OR AUTHORIZED AGENT DATE <br />X <br />IIEDAL c[BcnlPNerr rr1IOPESTY01NMw OELUWon ATItCRFOUncerIFM <br />'L91 OLOCN_Or <br />' • - •- ••� <br />PROJEFT.ADDRE S ''` <br />APPLICANTSCITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />7r <br />4 <br />WATER CLOSET(TOILE IT <br />_ <br />_ <br />_Q0 <br />AIR COND. UNI TS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITE-H.P. EA <br />LAVATORY WASH BASIN) <br />_ <br />_ <br />UQ_ <br />au <br />_ <br />BOILERS -/LP. EA. <br />8110WER <br />z <br />OAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSI EMS-B.T.U. M EA <br />_ <br />DISIIWASHER <br />00 <br />WALL HEATERS-B.T.U. M <br />_ <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS-B.I.U. M <br />CLOTHES WASHER <br />_O <br />Qp <br />_ <br />EVAPORATIVE COOLERS <br />_ <br />I <br />WATER HEATER <br />I <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR IIANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEAUERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE -BAR, ETC) <br />WOODSTOVE/FIREPLACE INSERT <br />�i8 <br />U <br />BUD TOTAL IT <br />SUB TOTAL <br />PERMIT • <br />PERMIT IT <br />TOTALFEE • <br />�L <br />_ <br />O� <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />INN BE(RACK nE nBC (BACK BIDE SETBACK PLAN CNECKNUMRER,.ATq,p,+ . PLANCHECKFEE <br />�A�VArA D� L.�..... �......iv ...�.. y. L.«.. (RECEIPT NO <br />LONE IOTA yACANf RITE <br />—`I i!E[ YAWA110N ![[ <br />fi.lil. I is n, <br />NO Or DINEL <br />I <br />G.. c <br />BUILDING <br />PLUMBING <br />11ECHANICAL <br />OIHER <br />PENALTY <br />TOTAL <br />0 <br />1 <br />