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shoFFpnFR <br />. PPLICATION FO..' <br />OF <br />CITY OF <br />C <br />CONSTRUCTION <br />Be <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />2SU-8745 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ y DEMOLITION ❑ COMBINATION BUILDING . • ❑ MECHANICAL ', <br />❑ PLUMBING <br />❑ SIGN <br />OWNED <br />�V6UN6 <br />MAIL ADDRESS CITY ZIP• <br />ZZ) 33gUFIV SoA toi,. 9S155 <br />PNONE <br />3�5z_3�r <br />ARCHITECT OR OESIG'IER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />L <br />I.ENEAAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />MFCHANICAL CONTRACIOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSI. <br />Ed NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ DUILDING RELOCATION <br />/ArTION F WORK OF MATERIALS PLUS LABORI <br />IESCRIB ORK <br />A/Ac al A (_ D 1 F'r <br />USE OF BUILDING <br />. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOWTHESAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />I <br />N IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCT ION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X �L/' <br />APPLICANrB CIrY LICENSE NB/ <br />; <br />I.EGAL DESCRIPTION UI'PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES, <br />S %tAt� D 3(i 'J9 <br />• <br />so A4 Lda� <br />I WOJECT AODRESS <br />AirVFQ)_Y 4NNE. <br />PLUMBING <br />_ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />Q <br />AIR COND. UNITS—H.P. EA <br />'J <br />S— <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />J— <br />LAVATORY JWASH BASIN) <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS—B.I.U. M EA. <br />DISHWASHER <br />0 <br />6b <br />WALL HEATERS—B.T.U. M•_CY7O <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />URINAL 5 Y <br />`�— <br />VENTILATIIN FAN <br />DRINKING FOUNTAIN <br />RANGE HMOFLOOR <br />DRAIN <br />AIR HAND_IN3 UNIT— C.F.M. <br />VACUUM BREAKERS, <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />SINK SERVICE -BAR ETC. <br />METAL FIREPLACE f CHIMNEY <br />WOODSTOVE/FIRELL ACE INSERT <br />f� <br />_ <br />SUBTOTAL <br />O <br />SUBTOTAL f <br />LosOO <br />_ <br />PERMIT f <br />PERMIT f <br />_ TOTAL FEE f <br />O <br />TOTALFEE fzil <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />J <br />tlLAN BE TRACK <br />22 O <br />SIDE SETBACK <br />5 <br />PLAN CHECK NUMBEF <br />� I�.'. <br />F qq <br />'�'` •� <br />LOTAiIgEA/—Y <br />.'. d.71i/. '• <br />VCANT 911E <br />.2:S ONO <br />FEES <br />I nv.....,nc..nv enuo <br />BUILDING <br />• <br />�, <br />NO. OF STORIES <br />/ <br />MAX OCC. LOAD <br />••� <br />PLUMBING <br />IKLERS REOUIRED D YES Y NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />ACC. BY <br />PUNS CHECKED BY <br />APPH. FOR ISSUANCE BY <br />S <br />PLAN CHECK FEE <br />�_o I RECEIPT NO S'33a 7 <br />VALUATION I FEE <br />/ <br />