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APPLICATION FOB <br />CITE "" OF <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />%[� /DLSIGNCR )/nJr.JsiNl% <br />ARCMN LCI OR <br />MAIL ADDRESS <br />80/S- C�iZCA�[a« <br />MAIL ADDRESS <br />CITY <br />• &u E?eT/• <br />- CITY <br />ZIP <br />gypo S/ <br />ZIP <br />PHONE <br />PHONE <br />GENERAL CONTRACTOR <br />./MAIL AOORC55 <br />/7.2N9E✓c//Dca�oi>a.%� <br />C_ CITY <br />COCITY <br />ZIP <br />n��yo 1' <br />PHONE <br />j � � %TART <br />LICENSE• <br />Q/.�-ANCtf /Yf//t <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />P11ONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />CLASS Of WORK <br />❑ NEW �0 ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />vALUAT N Of WORKICOST Of MATERIALS PLUS LA.BORI <br />�DOoA a� <br />DESCRIBE WORK <br />/A:n/� A./ � r..�c`S - %.-T/ii-`/•�i> . 1A77/_"L7 .(fit'/•iG///.V!.i .�%/%7�i! <br />Li+'/Z itUSE <br />BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />(qq/)�F <br />f12L'L'i%lw rote,- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERIYISHOWN DILLOW OR ATTACH FOUR COPIES( <br />OF WORK WILL BE COMPLETED WITF: WHETHER SPECIFIED HERE- <br />LOT—SLOCK_—OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />Q A -- <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF,,ONTRACTOR OR AUTHORIZED AGENT DATE <br />X� <br />PROJECCIADDDRESS <br />APPLI ANTS Y BUSINESS LICE145E NO <br />.o .] „ Ln ��iY L u'0, . <br />MECHANICAL <br />_PLUMt'BING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H P. EA_____ <br />BATHTUB <br />REFRIGERATION UNITS-H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS-11. P. EA. <br />SHOWER <br />GAS FIRED A . UNITS -TONNAGE EA. <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-BT. U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE 11000 <br />_ <br />FLOOR DRAIIJ <br />AIR (HANDLING UNIT- C F.M <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS- RAI NL EADERS <br />METAL FIREPLACE A CHIMNEY _ <br />_ <br />SINK (SERVICE -BAR, ETC I <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />_ SUB TOTAL f <br />-_ <br />PERMIT & <br />PERMIT S <br />TOTAL FEE f <br />TOTALFEE & <br />THIS POR T ION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK HEAR SETS Y. SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />�'_7 lk,310 FEE 213 RECEIPT NO <br />USE2 , -/ LOT/ABEA VACANT SITE FEES VAWATION F (/ <br />❑YES /\SIT <br />1(faN51 <br />OCCUPANCY GROUP <br />NO Ur UWkLI <br />F BLDG <br />NO Of STORIES <br />MAX OCC LOA <br />/}'2 ,t�e <br />/ <br />Z <br />FIRE SPRINKLERS REOUIRED ❑ YES NO <br />APPLICATIONACC BY PLANSCHECKEDBY APPR FOR 15'iUANCE BY <br />Z_ C <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />w— <br />