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I Ev ,»B t-.PPLICATIGN Was <br />CITYCONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING )4 MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />1 n CITY ZIP PHONE _ <br />i EL.1 vi, I +FI VI G 1 � 'F.i� �1 70PI`I\ 1TL'f• F1100. N, OGi-LPL 1)17IT — II ct <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />MAI_ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />[glrnrFr I,IiP•`Ill <br />l <br />f ne'a�. ?,U11 l�nvts <br />cVcKL'lt <br />%Fi:{(1, <br />1'.i1 31111 <br />EVfG�sSa ,L: <br />%UMBI GCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />FIIDNF <br />LICENSE A <br />CLASS OF WC AI <br />-- <br />❑ NEW L7 ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOOOSTOVEIFRPLANSERT ❑ <br />BUILDING RELOLATION <br />VALUATION OF WORK (COST Of MATERIALS <br />PLUS LABOR) <br />DESCRIBE WORK <br />1 1 I V I) (I Q11, <br />Jf^TI la <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE CCMPLETED 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 OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK ­ OF <br />PROJECT ADDRESS <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />Z <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY(WASH BASIN) <br />8 ALERS-H.P. EA. <br />SHOWER <br />_ <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-8. T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING'OUNTAIN <br />I RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />WOODSTOVEIFIREPLACE INSERT <br />1 <br />BUR TOTAL <br />SUBTOTAL B <br />PERMIT B <br />PERMIT B <br />TOTALFEE B <br />TOTAL FEE B <br />-S <br />THIS PORTION TO BL COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SEIOADK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF OWEt LING UNITS <br />BUILDING <br />$ <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />MECHANICAL <br />-��• <br />`- <br />OTHER <br />- <br />PENALTY <br />APPLICATION ACC BY <br />J <br />FLATS CHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />