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"APPLICATION FO.e evereU <br />CITY <br />EYerpr/en <br />cm of CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />1.11 7IP PHONE <br />ARCHI T ECT OR DESIGNEA� MAILADDNE55 <br />conl ���sTlc lNc PiS FT/ SE �2/[tA�'�!�_ggd � ��IZ-24e <br />Jcsr <br />IRESS ADDCITY ZIP PIIONE LICEN9E <br />GENERAL CONTRACTOR Y ( NcRrNNN3S-�� Y <br />/( II h /r993-MS <br />MECHANICAL CONTRACTOfl <br />MAIL AODRE59 CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR <br />MAILADDRESS CITY ZIP PHONE LICENSES <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION )SJ ALTERATION ❑,^REPAIR ClDEMOLITION ❑ WOOOSTOVE/FRPL. INSERT Ej BUILDING RELOCATION <br />VALUATION OF WORK(COS7OT MATENALS PLUS LABO QdOr% IT/ <br />�G/iddL- GX/s'/iy�r 5/CrN /_/�'�/(f PYti�/✓ � /NSr/��` N'� � <br />DESCRIBE. WORK <br />USE OFBUILDING . / <br />¢ <br />�G1✓%i: <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />QC4� _ S'/fUPPA/V <br />OVERNiNGTHISTYPE <br />LEDs PnouOF.---- ISIIOWNBELOWORAiTACHFOURCOPIESI <br />ERSPECIFIED HERE• <br />OFWORKWILLLBECOMPLETOEDWITHWHETHCES <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />Lor__BLocK._-oF <br />VISIONS OF <br />TERSTIVIOLATETY TO OR CANCEL THE �S <br />RUCTION <br />ANYO HGIVE <br />ATEOR OC LLAW REGULATING CO <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTAA�700 THORIZED AGENT GATEz <br />X <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />�IPROJECT ADDRESS <br />r,� ♦� C�2�'lti UV / r <br />PLUMBING <br />FEE <br />MECHANICAL <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />AIR UNITSUIUIT. <br />WATER CLOSET (TOILET) <br />RIGERCONE. <br />REFRIGERATION UNITS-H. P. EA. <br />BATHTUB <br />BOILERS <br />LAVATORY (WASH BASIN) <br />A.C.EA. <br />GAS FIREDACUNITS-TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />KITCHEN SINKA DISP. <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-D.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOT14ES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE & CHIMNEY <br />ROOF DRAINS -RAIN LEADERS <br />INSERT <br />SINK (SERVICE -BAR, ETC.)WOODSTOVE/FIREPLACE <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />S <br />TOTAL FEE 5 <br />TOTAL FEE <br />S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN CHECK NUMBER PLAN CHECK FEE <br />FRONT SETBACK HEAR SETBACK 910E SETBACK FEE RECEIPT NO <br />USE ZONE LOTAREA VACANT SITE FEES VALUATION FEE <br />OYES ONO <br />1 TYPE OF CONST. OCCUPANCY GROUP NO.OFDWELLINGUNITS -_ <br />BUILDING S <br />I SIZE OF BLDG. NU. OF STORIES _ IAA%. CCC. LOAD <br />T <br />PLUMBING <br />( MECHANICAL <br />t <br />FIRE SPRINKLERS REOUIREO ❑YES ❑ NO OTHER _ <br />I PENALTY <br />APPLICATION ACC. BY PLANS CHECKED BY APPR.fORISSUAN 50 TOTAL <br />I <br />/Z. <br />