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AiPLICATION FOR EYEEER <br />CITEOF <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />OWNER "An AVDn1.59 CITY TIP PIIpNL <br />ARco�C-f��Eu� �u�s Co. l901 IIoe'--Av.,Ai-J,1/o7- R�D^�Ll^�b 52 <br />ARCNIIEC1 UR 11l SIUNfn M4LF-AVRRL 55 I:IIY fll' N OIII. <br />ARC�HAUSEN C�Ns�rnNG CNIo I�iz/S '%l ` 4ve S. e, gong;?-P(?oGJ 2S/ (0272 <br />GENERAL CONTRACTOn MAIL ADDn[SS CHI I'll PHONE LICENSE A <br />MECHANICALCONIRACTOR -Alt ADDRL SS CITY b? PILONE LICENSE <br />II � <br />PLUMBING CONTRACTOR <br />MAILV0nE 55 city I'll PHONE LICENSE A <br />tE n 1 <br />CLASS OF WORM <br />W ADWDITION ❑ ALTERATION El REPAIR ElDEMOLITION ❑ WGODSTOVE/FR PL.INSERT ElBUILDING RELOCATION <br />VAL VAiINE <br />ONOF 9-IC.Dsr OE 1.UtEnMLS PILnnnm <br />1* u 6_ `1i,7 D 2l f tee, .r'L - F/ <br />OFSCRIdE WOnK <br />10 ./.�t) .-T Z .—i_,,/ /710 4i z 77-n//i.7 Nc]Pc/). //n/�E,P�.aou lJn %.drt/�'G <br />�VLv9l/SURE LI I v - <br />_ <br />USE OF BUILDING C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />E /It G/70CE/? J J <br />PLICATION AND KNOW THE SAME 10 BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION CI PR IPERIYI9H0 NBFLow olul A", rouR comE sl <br />- <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BI OCK or <br />W OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />Er 'd ZcAtf 2�) <br />ANY OTHER STATE OR LOCAL LAW REGULATING L:ONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR On AUTHORIZED AGENT DATE <br />2� <br />PROJEC r ADDRESS <br />APrIIf.A 911CLNSEq <br />C.AS/A/o hJ. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />AIC - AIHNOLO UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - HP EA <br />L AVATORY (WASH BASINI <br />BOILERS - E - U /H P <br />SHOWER <br />GA5 FIRED A C. UNITS - B T U <br />KITCHEN $INK 6 DISP <br />FORCED AIR SYSTEMS -BTU M EA <br />DISHWASHER <br />WALL HEATERS -B T U M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOIN PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE B CHIMNEY <br />FIREPLACE INSERT <br />HEAT PIJMP <br />GAS PIPING <br />EXHAUST FAN <br />MPERMI <br />SUBTOTAL <br />1 <br />PERMIT <br />! <br />TOTALFEE <br />IT� <br />I PfINI SETBACK �--•nCAR <br />4q.AN .,r CK^NUMBER <br />U <br />FEE ^�I <br />3. Q�2' <br />uVUAL/UATIONffIJJJ <br />RECEIPT NO <br />_I1 <br />5L1oALM —^SIDE <br />SETBACK <br />U.if ZZONE <br />LOI HEA <br />VA -ANT SITE <br />FEES <br />FEE <br />BUILD( / <br />s 43, jog <br />! -2G <br />d <br />✓sir/s�7 <br />33 oao s� <br />�ES ONO <br />M`f O-'ON51 <br />OCCLIPAIICY f. Llr 1!O <br />Of DWELL ING IIN115 <br />h/ <br />2. a �� <br />-ep <br />PLUMBING <br />SIZE Or BLOC <br />6-2 2'1 JF <br />IN Or S10 n5 <br />/ <br />MU Oc"c LqOAD <br />—<--- <br />MECHANICAL <br />OTHER <br />r� / 170F? <br />FIRE SPRINKLERS REQUIRED ❑ YES CLNO <br />STATE BUILDINC SURCHARGE <br />^�L,, <br />$L� <br />STATE ENERGY SURCHARnE <br />/ <br />AVPIIC.lION41': BY <br />PLANS CHECKED By <br />APPR FOR ISSUANCE BI <br />(.DdLIC WORKS <br />TOTAL <br />f <br />JaO <br />P cna nFTF-RMINING <br />ALL <br />P90PERTY LINE LOCATIONS AND RELATED EASF ME NTS <br />