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-.PPLICATION FO1. e,PFPR <br />MOO EYSIpleen III• OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION IXCOMBINATION LI BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />r.1A11 APONL aS f.Ny III' P110N1. _ . <br />MAIL Afl➢NLSS UlY .11 I nllm <br />t MMI eU110LS5 --.— TIN--- -- lu• I4nbll I1GI NSE . <br />ids 2407• 38T=' 5T Sv_A9eEr_r 90 1 1759 _5;94L i&-0cfc v -t7<4 <br />L,A., AIIDULSS CIT, hi• Pu0111. IWO, I . <br />Pl11MBINIi 1:ONiRACIon <br />MAR ADRALSS-------_— I.IIY lll'—_--1•nn1U TIC t11SL. <br />CLASS Of WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION pl REPAIR— DEMOLIIION ❑ WOODSIOVE/FRPL.INSERT _ BUILDING RELOCATION <br />.�$'1AL WTLON OF WORK ICOSI Of IAA1C RIAI.S PI US LARORI <br />DE SCRIOC WORK 1 n <br />/ l l ./rA. A.P .... o.. I.G.• �>l.f• / /...T <br />1 CA,ivvc .t/frcP_)q?4 T.V6 <br />, - --�­-A-- <br />USE OF BUNBING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />J-QStWAECG A!�LS !n /301L 0/tib <br />PL ICAT ION A N D K NOW Th E SAM E TO B E TR U E AND CO R RECT.ALL <br />PROVISIONSOF LAWSORDINANCES GOVERNING T HISTYPE <br />LEGAL DESCPIPIK)N OF PROPCRIYISIIOWII BCIOW OR PIIAdU 011R faRESI <br />OF WORK WILL BE COMPLEIHD WITH WHETHERSPECIFILD 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 />ANY OTHER STATE OR LOCAL. LAW REGULATING CONSTRUCTION <br />OR TItE PERFORMANCE OF CONSTRUCTION <br />— <br />._---—___..--_----- <br />W11E0IIIIIt III I:UN1UA1.I0N 1111 AIIIIIIII4111 U Ail[ 141 MAII <br />it f g AFAR 17, 1y08 <br />41'1'1 II Alli '. I.11V III I`.1111 `.:I1 II I ..... 11 <br />1'11(1.If Gi AaDll[ES <br />/iyvg <br />4405 5. 3RO Aoc <br />MEC14ANICAL LY/r� <br />PLUMBING 1,/N <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />Alf,- AMNOLG UNITS —11 P <br />WATER CLOSET ITOILETI <br />REFRIGERATION UNITS — HP EA <br />BATHTUB <br />BOILERS NIP <br />LAVATORY(WASH BASIN( <br />GASFIRR8Tll <br />GAS FIRED AC UNITS —BTU <br />D <br />SHOWER <br />-- <br />PURGED AIR SYSTEMS — BTU M EA <br />KITCHEN SINK & DISP <br />WALL HEATERS-8 TU M <br />_ <br />OISHWASHER <br />_ <br />UNIT HEATERS — BTU M <br />_ <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />_ <br />CL OTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />-- <br />DRINKING FOUNTAIN <br />RANGEHOOD <br />FLOOR DRAIN <br />__- <br />WATER HEATER <br />_ <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEAOEF.S <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE — BAR. ETC I <br />FIREPt ACE INSERT <br />_ <br />HEAT PI IMP <br />-- <br />GAS PIPING <br />EXHAUSTFAN <br />sus TOTAL f <br />1 <br />SUB TCTAL <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />TOTAL FEE <br />I'1 AN CHECK NUMBFA <br />FEE <br />HECEIPT NO <br />REAR Sk (BACK <br />910E SETBACK <br />usL ZONE <br />LET AREA <br />V.I;AUT SOIL <br />FEES <br />VALUATION <br />FEE <br />g <br />_ <br />BIIIL'..INO <br />i <br />rvl'L OC fON I <br />OCCUPANCY GROUP <br />NO In OWf I LNG UNITS <br />N <br />PLUMBING <br />S(i OF IT Da <br />NO of STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />.V,4 <br />•is "r <br />-- <br />OTHER <br />STATEBUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED Q YES NCO <br />STATE ENERGY SURCHARGE <br />AT PIIC4110N ACC BY <br />PLANSCNECKEDBY <br />'ll f00ISSUANCE BY <br />PUBLICWORI(S <br />_ <br />TOTAL <br />ul:mnuciRl F FOR DFTERMINING ALL <br />7 <br />I>ROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />