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, .PPLICATION FOE. <br />the lNn <br />CITY OF <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259 874b <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION II COMBINATION 11 BUILDING I I MECHANICAL ❑ PLUMBING <br />fA SIGN <br />OWNER <br />null Ann RLSS le,, !II' PIIONF <br />p.ffisart-SKI:smFo <br />`m.'aRt .dY�---- EHIec�BTT <br />ARCNITIGI OR DESIGNER <br />M.,I .009EF5 CITY bP PHONT: <br />GENERAL CONTRACTOR <br />MAIL An11RI ss CITY ZIP P.MNE <br />110ENSE A <br />veEuorz..Ao,�r�t�nl_3�J51'�Ave. <br />c�� LA9a q>�_�el-anl S,�aowly�at� <br />rlmra <br />uC.ENSE A <br />MLUTANDC-1 CONTR>rmR <br />NIAR AOOALss cl nr <br />PLGMBINGCONTRAC.IOR <br />MAIL AODnLSS CITY ZIP PHONE <br />IICLNSL. <br />CLASS OF WOnK <br />91 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑-DEMOIIIION ❑ WOODSI OVE/FFIFE. INSERT ❑ BUILDING RCLOCAIION <br />VAL UATION OF WOnN ICOSI 01 MAIL RI.15 PI US I WORI <br />--.- <br />DESCRIBE WORI, <br />DING <br />I HEREBY CERTIFY THAT I HAVE REAL AND EXAMINED THIS AP- <br />PLICATION AND KNOW TI4E SAME TO uE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIUNL OI CONTICACIPALqA AUTHORIZED AGENT GATE <br />s/1117 <br />APPucANrscaYBusmcss LlcENsE No <br />PROJECT ADDRESS <br />MECHANICAL <br />_ <br />PLUM <br />NO <br />FEE <br />NO. <br />TYPE OF EOL"PMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />_ <br />AIR COND UNITS—H P. EA <br />_ <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS—H.P EA. <br />BATHTUB ____ <br />BOILERS—H P. EA. _ <br />LAVATORY_!WASH BASIN( _— <br />__ <br />GAS FIRED A C UNITS —TONNAGE EA_— <br />____ <br />SHOWER <br />_ <br />_ <br />AIR SYSTEMS_B. T_U. M EA <br />KITCHEN SINK f DISP <br />___ <br />_ <br />_ <br />_FORCED <br />__ <br />((EATERS—BT.0 hi <br />DISHWASHER <br />_ <br />__ <br />_WALL --- <br />_ <br />__ <br />UNIT HEAIERS—B T.0 M_ <br />_ <br />LAUNDRY TRAY <br />_ <br />_ <br />_ <br />EVAPORATIVE COOLERS__ <br />_ <br />— <br />CLOTHES WASHER <br />WATER HEATER --- <br />__ <br />_.— <br />CLOTHES DRYERS___ —__--_—__-- <br />_ <br />VENIILATION FAN <br />URINAL <br />_ <br />— <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />— <br />_ <br />__ ______ <br />METAL FIREPLACE f CHIMNEY <br />ROOF DRAINS—BAMLEADERS _ _ <br />_ <br />WOODSTOVE/FIRE PLACE INSERT <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT f <br />--- <br />PERMIT f <br />TOTAL FEE <br />TOTALFEE _-_ f_--_____-_-------- <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />