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�1: PPLICATION FO'�.) <br />CIne <br />T'r`"° CONSTRUCTION <br />ua <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION I�r-BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS - CITY ZIP PHONE <br />MAIL <br />ZIP <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICE 115E- <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ® DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUA710NOF WORKICOSI OF MATERIALS PLU: LABOR) <br />Tr MA/. ­AAI mr aL nan G.c <br />USE OF BUILDING <br />I HFREBY CERTIFY THAT I HAVE READ AND EXAMINED ThIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRE'.T. ALL <br />PROVISIONSOF LAWS AND ORD I NANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE TY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY O HERSTIATEOR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWOR ATTACH FOUR COPIES) <br />16 VL• aA honl%s <br />LOT—BLOC _ of <br />Cvvn�4 (I�G101iinQ cic / <br />Q Q /CL JO <br />yamP/4 <br />RQCO2DS n1 (,opmlr v f <br />RO Ct ADDRESS 90 ( b F� �,QQL-AK LI�U <br />�eau..fi{- ala�i.I, q 8203 <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FI'LTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-M.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASINI <br />BOILERS,-H.P. EX <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 />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 FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE -BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTALFEE 3 <br />TOTALFEE 6 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SILO SETBACK PLAN CHECK NUMBER PLAN CHECKFEE <br />FEE RECEIPT NO, <br />USE ZONE LOT AREA VACANT SITE <br />FEES VALUATION FE[ <br />OYES ONO <br />PPE OF CONST. OCCUPANCY GROUP 146. OF DWELLING UNIFD - <br />I _ BUILDING $ <br />NO OF STOGIES MAX. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />IKLERS REOUIRED ❑ YES ❑ NO <br />OTHER <br />_ PENALTY <br />ACC BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />TOTAL <br />r <br />21 <br />