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IA. EYFrVnA*n i4OPLICATION FOK <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER <br />MAIL AWRLSS <br />ZIP <br />❑ SIGN <br />F1,12ST l tTT ST' =-- � 999 l o u s ��T fl I--. WA, 98104- 02 4 <br />ARCHITECT OR OLSIGNCR MAIL ADDRC SS CITY ZIP <br />PHONE <br />MVEMA" A20-lt=- 1(0JZ HEWITE A1t-TL-Aa) RlgEP,L 7 V((A9pppl �L3-31(o1 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE LICENSE <br />❑ NEW ❑ ADDITION YG ALTERATION ❑ REPAIR ❑ DEMOLI110N ❑ WOODST'OVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VA AnaN Of WORK )COS T OF M ATERIALS PLUS LABOR) <br />�O DOO A DO <br />DESCAIBE WORK <br />(Td�u croluc�^ r rta� xrv� /�Jcrr �i1 iP__ <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 AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />ITY T VIOLATE OR CANCEL THE PROVISIONS OF <br />ATE LOCAL LAW R ULATING CONSTRUCTION <br />4PERFO <br />NCE OF CON CTION. <br />N ACTOR OR IZ AGENT D TE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_�p__Bloc of 'PLAT nF �C-k(5= <br />PROJECTGADDPEBS <br />p 1-7 -- <br />ASS TILE NSe NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/O — AiHNOLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS —H P. EA, <br />LAVATORY ( WASH BASIN) <br />BOILERS — BIT U /H P. <br />SHOWER <br />GAS FIRED A.C. UNITS —B.T.U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS — B T U. M EA, <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL _ <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />1 <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADEHS <br />WOOD STOVE <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVTCE — BAR, ET(, I <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />TOTAL FEE S <br />TOTAL FEE <br />17RONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHQICK NUMBER <br />FEE ��A <br />RECEIPT NO <br />usE t <br />I.OT AREA <br />VACANJ�O SITE <br />OYES <br />/V <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />fi <br />TYPE OF CONST <br />OCCLIVNCYGROUP <br />NCN/ _ / <br />NO. OF DWELLING UNITS <br />—AQ— <br />PLUMBING <br />SIZE OF B:OG <br />NO OF STOWES <br />? <br />MAX OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED ❑ YES XNO <br />APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br />sk C <br />OThER <br />STATE BUILDING SURCHARGE <br />C <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />pL O <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />