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%PLICATION FOIO <br />evrreR <br />CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />a <br />259.8810 TO BE COMPLETED IN INK •PLEASE PRINT <br />i <br />❑ DEMOLITION ❑COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br />1 <br />MAR AOORf SS CO, 711, PUONf <br />DWCR '' True K l�RrS rNc. Z I BvZ HLO EDrT ►cps 98ozo 77 tom$ <br />'� ARCHITECT OR DESIONfn MA11 AUOIIF55 f11V Iw PIIOIII <br />I'. <br />LICENSE A <br />Mul AOlInf SS Cllr --_- 111• vNONT <br />GENERAL CONTRACTOR <br />MU)Nf LIC[NSE <br />CNANICAL CON TRACTOR MAIL AODRESS CITY TIP <br />( <br />PLGMBINR CONTRACTOR MAIL ADORE SS CITY 111' R41NI IICENSEA <br />CLASSOF WORK <br />[IREPAIR ❑ DEMOLITION ❑ WOODSTOVE/f RPL INSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />1 VALUAI1ONO' WORK ICQglofMAIf"'A'"'P1u5I.APOR, 1\ <br />�� �� ��RFA _L►LSJ p� �X�STI nlC—�A� <br />1 DESCRIBE WOR. — <br />REST aD m7 > 4 5S HbF' A AAA —T <br />,CUBE py 9LIr g1I+G it_�/•y� I I (�AIX,� 1. U/ IL• 1 HFREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCC^RECT. ALL <br />LEGAL DESCRIPTION Or PRC mr1RIR>wN mLow GnAneulHron ufr11 s1 PROV15IONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT THE GRANTING OF A PEFMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CC; aSTRUCTION <br />OR 1HE PERFORMANCE OF CONSTRUCTION. <br />y SIGNATURE OF CONTRACTOR On ALITt1ORIZED AGENT RUE <br />x 7 i9-88 <br />r ��.N�ArPr cnr Bu tsBu NSE No <br />PROJECT ADDPESS n <br />z3t5 w. C14,SrAb RA E•vfJ2E,r <br />PLUMBING MECHANICAL <br />V <br />TYP[ OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) A,C - A'HNDLG UNITS - H P <br />BATHTUB REFRIGERATION UNITS -- H P EA <br />LAVATORY (WASH BASIN) BOILERS - B T U.H P <br />'I SHOWERGAS FIRED AC UNITS - BTU <br />.I KIT CHEN SINK 6 OISP FORCED AIR SYSTEMS — B T U M EA <br />< DISHWASHER WALL HEATERS — B T U M <br />J LAUNDRYTRAY UNIT HEATERS - B T U M <br />'1 CLOTHES WASHEREVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN VENTILATION FAN <br />NGE HOOD <br />FLOOR DRAIN RA <br />L BACKFLOW PREVENTERS WATER HEATER <br />WOOD STOVE <br />ROOF DRAINS - RAINLEADERS <br />SINK (SERVICE - BAR. ) METAL FIREPLACE 6 CHIMNEY <br />ETC <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />i <br />'I THIS TOTAL i SUB TOTAL <br />' PERMIT E PERMIT <br />TOTAL FEE ! TOTAL FEE <br />• __ RAN CH K NUMBER FEE RECEIPT NO <br />FRONT SETBACK nHnSETBACK SIDE if TBACK J��I^5� / <br />{// <br />FEE <br />USE J E LOT AREA VACANT SITE FEES VALUATION <br />ES O S <br />BUILDING <br />TYPE OF CO ST OCCUPANCY GROUP NO Of DWELLING UNITS <br />• PLUMBING <br />911 BRIG NO off 9jo"ES MAX Of.L LUAD MECHANICAL <br />,i , on1En -- <br />1 <br />FIRE SPRINKLER:i REQUIRED LI YES NO STATE BUILDING SURCHARGE r <br />a <br />STATE ENERGY SlRCHARGE <br />APPLICAIIDN ALF PLANSCHECKFO BY APPR FOn ISSUANCE BY PUBLIC WORKS <br />TOTAL <br />DETERMINING <br />PROPERTY OWNERS ARE RESPONSIBLE FOR <br />PROPERTY LINE LOCATIONS AND RELATED ASEMENTALL <br />