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OF ^PPLICATION FOL_ <br />CITY OF <br />CITECONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT i <br />269.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />fikDEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE I <br />12. R. Plll'��c Sole Bq,vtR!, 2AvA L-ye,Re._U Uh g6203 353-2q,80 <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHON. <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />zl� b -- T ;,I - - sc(j <br />-- <br />MECHANICAL <br />MAIL <br />CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />:LASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ® DEMOLITION ❑ WOODSTOVE/FRPLANSERT Cl BUILDING RELOCATION <br />/ALUATICN OF WORK (COST OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK /N AOVIA+ W <br />�rO "qLS n 4 <br />wrHrOAVS /N:T4 /-Jr- <br />nTOr'Mr- <br />DQ,5NA7rt Z7,. <br />USEC�IBUILDING f1 <br />JTV1 le IU es;de -tCQ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPER (SHOWPI BELOW OR ATTACH FOUR COPIES) <br />ZG 6 1CS R LMt 1 <br />PROIECT ADDRESS 8016 j/Y QVCQe]6 UVOI s n <br />� C <br />APPLICANTS CITY BUSINESS LICENSE 0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <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-B.T.U. M <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES URYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDI ING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC.) <br />_ <br />WOODSTOVE/FI REPLACE INSERT <br />SUBTOTAL <br />SUS TOTAL f <br />PERMIT $1 <br />_ <br />PERMIT f <br />TOTALFEE $I <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'HUNT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />I PLAN CHECK NUMBER <br />✓LAN <br />FEE <br />CHLOK FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY CROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />IT <br />SIZE OF BI DO <br />NO. OF STORIES <br />MAX. OW. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />- <br />PENALTY <br />APPLICATION ACC BY <br />A✓^/,/� <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />.,T,� yn <br />TOTAL <br />►i <br />