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IM EWArgri.R <br />COY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />i.PPLICATION FOB <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COI, .,NATION ❑ BUILDING ❑ MECHANICAL $I PLUMBING ❑ SIGN <br />OWNER MAIL ADDHE Si LI1Y ZIP PHONE <br />I� ch.k G,•- I, 5?.- '�rvPr�.� �PPd10- 771E—�B�L <br />TP PNONF <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE• <br />r L Luaa <br />o-yv Qr le G 9 <br />�uPisx s Awe. — <br />Q 9+_01_ C_ -7 1 u—_ 21? 16 <br />MEC UNIGI DIIi RA CTOR <br />MAIL AODRE55 <br />CITY <br />ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS � CITY ZIP PRONE LICENSE c <br />44 Sol - Li fe PPL(�LE(v- n 8 -2-7d 3-m-w5n Rje aaL j i, ICp <br />CLASSOF WORK <br />❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION <br />OF <br />Lam. 4 1,w7-i1 d,.. & <br />USE OF eUILDING <br />Lvv, c.• P <br />I HEREBY CERTIFY THi:T I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />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 />LEGAL DESCRIPTION Or PROPEPTYISHOWN BELOW OR ATTACH FOURCOPIESI <br />LOT —BLOCK — OF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <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 — AMNCLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T U /H P <br />SHOWER <br />GAS FIRED A C. UNITS — B.T.0 <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.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />_ <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE —BAR. ETC 1 <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />14ONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BIDO <br />NO OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />OTHER <br />_ <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />1 <br />APPLICAIIONACC BY PL.VISCHECKEUBY <br />APPR FOR ISSUANCE By <br />TOTAL <br />PROPERTY OWNERS APE RESPONSIBLE FOR DETERMINING nLL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />