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k. <br />the Evn°FMR ST DT Ocm of CONRUCIN <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING EI MECHANICAL <br />OWNi��R)) n T MAII. ADDRESS CITY ZIP <br />C I I , � C. n _ <br />S IV <br />ADDRESS <br />everefY <br />e <br />❑ PLUMBING ❑ SIGN <br />-/z <br />!II' <br />PRONE LICENSE <br />ZIP <br />PHONE LICENSE <br />!IP <br />PRONE LICENSE <br />CLASS OF WORK �,/ <br />❑ NEW ❑ ADDITION L'1 ALTER4TION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAWAJJON OF WOO,RK(COST OF LUTE RIAL S PLUS LABOR, ,o /Ij//T �`* S t (� ^�.� /� <br />1 DESCRIBE 15-0O ` 1 AC -� ri — 1 LAB II' <br />WORK <br />A), -LAB Hook <br />USE OF BUILDING <br />Res�Ln� N <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR 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 />� �bL <br />L EGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />77-. <br />PROJECT ADDRESS <br />J t, aed UJr S � <br />�.U5- <br />_ <br />APPLICANTS CITY BUSINESS I.ICU5E NO <br />_ <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 — AM.NDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — HP EA —• <br />LAVATORY (WASH BASIN) <br />BOILERS -- B.TU/HP <br />SHOWER <br />GAS FIRED AC UNITS — BTU. <br />KITCHEN SINK & DISP <br />FORCED A+R SYSTEMS — B.T.0 M EA. <br />DISHWASHER <br />WALL HEA rERS —B T.U. M <br />LAUNDRY TRAY <br />UNIT HEASERS — B.T.U. M <br />CLOTHES WASFER <br />EVAPORATIV'_ COOLERS _ <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER NEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK ISEPVICE — BAR. ETC I <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />$ <br />SUB TOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTAL FEE <br />S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />{RONT SFi BACK <br />REARSETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OFDWFLUNG UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED 'I YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />_ <br />STATE ENERGY SURCHARGE <br />APPL ICATION ACC BY <br />PLANSCHECKEO BY 'aPPR <br />FOR ISS LANCE BY <br />PUBLIG <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />