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the EY.gnBn <br />an CA <br />EverFN <br />CONSTRUCTION <br />everett <br />PERMIT e <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION H BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL AOORESS Clh ZIP PHONE <br />MARVId .( r.4Yf7AR1f f <br />F,'b'L C4 nj' Ro /I n �f/1fTf 35 S -y r t y II <br />ARCHITECT OR OFSIONLR <br />MAIL ADDRESS Clh ZIP PHONE <br />GENERAL CONTRACTOR <br />NnKixl+ G0N,�7 7_f37_ <br />MAIL ADDRESS Gh LIP PHONE LICENSE F <br />Hl(rbLgA/O 4cjc-, EVF "rr `iSty/ u�-7ya <br />_ *� cY23uoy <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS LRY TIP PHONE IICFNSE <br />PWMBINU CONTRACTOR <br />MAIL ADDRESS CITY I'P PGON LICENSE• <br />CUSS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION 19 REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOIR - <br />f I y L <br />DESCRIBE WORK <br />KEPcSrf- FRDA1r I'otE4f 4o <br />STEpS <br />USE OF BUILDIVO <br />_ <br />90-ton,xer <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPI ION Or PROPERTYISHOWN FIR ON OR ATTACH FOUR COPIES) <br />I' <br />LOT 1 _. eL., V GF 13 EE115n L Y <br />/ 4 It- S 01 L <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRAVTI NG 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 �ORAUTHORIZED AGENT DATE pp <br />RRO/EC r ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />`bL. C90Y JZOAd <br />? 833 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FfE <br />WATER CLOSET (TOILE <br />AIR COND. UNITS -H. P. EA. <br />BATHTUB <br />REFRIGENATION UNITS -HP. EA. <br />IAVATORI' WARM BASIN)BOILERS-H, <br />P. EA <br />SHOWER <br />0, S FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK E DISP. <br />FORCEDAIRSYSTEMS-BTU. MEA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />! <br />KINK SERVICE -BAR ETCl <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />SUE TOTAL <br />d= <br />=FEl <br />PERMIT <br />1 <br />TOTAL FEE <br />1 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I FRONT SETBACK <br />REAR SE``/BACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />MAN <br />CHECK FEE <br />Zo <br />' W <br />IL <br />�%� �i nI F I I <br />a 7`�/ <br />FEE , `_ <br />G <br />RECEIPT NO ^ Y 4 <br />USE LONKP-S <br />LOT AREA <br />VACAN STE <br />FEE& <br />VALUATION <br />1 `-I <br />OYESO <br />FEE <br />TYPE Of 0 ST <br />`11/ <br />OCOUPANCY GROUP <br />NO OF DWELLING UNITS <br />40-- <br />BUILDING <br />3 �/�1 <br />�i <br />�j C� /'yl <br />F (d1 <br />SItE Of BLDG��// <br />NO OT STORIES�T <br />MAX OCC TOAD <br />/'Jv <br />IV4- <br />� <br />PLUMBING <br />TIRE SPRINKLERS REQUIRED DYES iCNO MECHANICAL <br />OTHER 1' <br />PENALTY <br />APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY _ <br />TOTAL <br />