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E <br />/-.x?PLICATION FOk <br />everetl <br />the G/MR <br />CITYOF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION LXBUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />O SIGN <br />R <br />MAUL ADDRESS CITY 71P <br />PHONE <br />TO <br />6 9/7 Fri/^o/ y irl 7o,-3 <br />-;77 <br />�}-/79W <br />77-/1/ ePW 9d <br />.3s 7 -) <br />An IFECT On DESIGNER <br />MAIL aODnEs^ CITY ZIP <br />CIyA/S <br />PHONE <br />6e h,W <br />nn 1� <br />Are)7I �PC� tr��/vs / �9G( -Z99{ 3.�3;2, <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE. <br />PLUMBIN O CONTRACTOn <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE . <br />1 <br />CUSS OF WORK <br />❑ NEW ADDITION <br />_ <br />❑ ALIERATION REPAIR El DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION� WORK (COST OF MATERIALS PLUS LARON <br />/OF <br />_ .�1._O I> A /A J rJ /7�///✓A H� �J/��J .I/Ji �//�%Y Y� W i�!/'/V�/�%�� . �% Jam//' �%J/ /A .L�Y?I-fI-fO O !T /�A/�T^ J <br />USE OF IL)ING - / / <br />v <br />O <br />_a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK IVILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OFA PERMIT DOES (JOT PRESLIME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />Of. THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE O�,CONTRACTOR OR AUTHORIZED AGENT DATE <br />- ry <br />APPLICANTS CITY DJSINESS LICE T NO <br />/%fir✓r�� .o <br />LEG SCRIPTION OF PROPER FY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />yl'r�.� f <br />LOT .L� BLOCK—o <br />- <br />,tile <br />PROJECT ADDRESS <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 - A/HNOLG UNITS - H.P. <br />BATHTUB <br />REFRIGERATION UNITS -H.P EA. <br />LAVATORY (WASH BASIN) <br />DOILERS - B.T.U./H P. <br />SHOWER <br />GAS FIRED A,C. UNITS - B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />-W HEATERS B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS -R.T.U. M <br />ELOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES CRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK ISERVICE -BAR, ETC.! <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />MEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />S <br />SUBTOTAL <br />— <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />sl <br />iOTALFEE <br />PLAN CH CK NUMBER <br />ac�s3I�- <br />FEE 5!3 <br />RECEIPT NO. <br />q767 <br />FRONT BETDACK <br />REAR SETBACK <br />- <br />SIDE SETOAC✓ <br />— <br />USE ZOT{L_ <br />LOTAREA <br />/ <br />VACANT <br />OYES O <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />5 i <br />TYPE OFIC/ - /NS`i <br />' yy <br />OCCUPANCY GROUP <br />e - Z <br />NO OF OWFLLING UNITS <br />^I3- <br />PLUMBING <br />SIZE OF BLDG <br />I ` <br />7 f• <br />NO OF STORIES <br />MAX OCC LOAD <br />Z� <br />MECHANICAL <br />OTHER <br />' <br />rL <br />FIRE SPRINKLERS REQUIRED ❑ Y ES 40 <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPUCAfION ALC BY <br />PLANS CHECKED BY <br />APPn FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY UWNER5 ARE HES'UNtlIULt rVH Ut I Blum NINU ALL <br />PROPERTY LINE LOCATIONS AND 71ELATED EASEMENTS. <br />