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IAF Ewrow" <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-BB 1 D <br />f,PPLICATION 1`01. EYEFER <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />W COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />M•II AOnnlss <br />CRY by, <br />PHONE <br />l�wUf63357/6/evPSE <br />3ELEyG 0o�r <br />69-7970 <br />nC TFLGF <br />MI ADDRESS <br />CITY <br />IHONLroK <br />IAy.f- <br />w6I7- 3356 <br />/1,/5rAVi sF jJQLEVUC 9SI6o8 <br />lyy- <br />74>6 <br />_gAgl <br />GENERAL CONTRACTOR <br />.•'I AD <br />ZIP <br />PHONE <br />I ICENSE <br />P`aCT1'115uvew"FIT <br />ZF Z/ Zl <br />GEV-7970 <br />MECHANICALCONTRACTOR R <br />LITv ZIP <br />PI <br />LICENSE IT <br />PLUMBING CONTRACTOR MAD ADDRESS CITY ZIP PFGNE LICENSE K <br />CLASS OF WORK�� <br />❑ NEW Ud" ADDITION ❑ ALTERATION ❑ REPAIR 2 DEMOLITION ❑ WOODSTOVEIFRPL. INSERT Cl BUILDING RELOCATION <br />VALUATION OF woM Ict Jl° MATERIAL S PI IS I ABORI <br />'TZ�'� <br />DF SCRIBE WORK _ <br />nBE _.Ji G.itr ,iil IlnIJAdi 9- SItF IZZUPPA.BT 7�15Wii <br />USE OF Eli DING r <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />C D41AAU WICAT/o/!/S <br />S'r� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY I5HOWN BELOW OR A I TACK F OUR COPIESI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IGI_BLOCK_DF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATIIRE OF CONTRACTOR OR AUTHORIZED AGENT DAIS <br />X '/' J <br />PROJECT ACORESS <br />APPIIf.A 5C1 Bit kSS UCL NSE O <br />'1 <br />709, Ui <br />c <br />v" <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — AMNOLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H P EA <br />LAVATORY ( WASH BASINI <br />BOILERS — B T U IH P <br />SHOWER <br />GAS FIRED A C UNITS — B T U <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS — B T U M EA. <br />DISHWASHER <br />WALL HEATERS-8 TU M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U ATCTHES <br />WASHER <br />EVAPORATIL'E COOLERS <br />URINAL <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PRE. ENTERS <br />WATER HEATER <br />ROOF DRAINS —RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC I <br />METAL FIREP'CE A CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />OAS PIPING <br />EYHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />{ <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />INONI SETBACK <br />PLAN CME .K NUMBER <br />FEE <br />RECEIPT NO. <br />REARSETBACK <br />SIDE SETBACK <br />USE LONE <br />LOT AREA <br />VACANT 511E <br />FEES <br />VALUATION <br />FEE <br />$ <br />OYESh1 0 <br />BUILDING <br />TYPE OF CONS? <br />OCf.11PANCY CROUP <br />110 OF DWELLING lIN115 <br />•-�� A Z <br />�7 <br />�• <br />PLUMBING <br />SIZE OF FIT DG <br />NO OF STORI 9 <br />MAK OCC LOAn <br />MECHANICAL <br />9owow <br />/625 <br />v.f <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES NO <br />STATE BUILDING SURCHARGE <br />r� <br />,J <br />STATE ENERGY SURCHARGE <br />APPIe:AIIONACC BY <br />PT ANS CHECKED BY <br />rOn ISSUANCE BY <br />PUBLICWORKS <br />1A.-Ily <br />G. G <br />TOTAL <br />meI c rno ncTCRM1 NINE it L <br />- <br />rnvrcm..... ._..--. _. <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />