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PPLICATION FO %'!- <br />fA• EY�rprnn ) � everett <br />CITY OF CONSTRUCTION r <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />O COMBINATION O BUILDING O MECHANICAL <br />PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADORES <br />Gil, <br />ZIP <br />PHONE <br />5� <br />% r /�/� <br />/ jC)l Cy«�-FL+'� <br />/' , 4 <br />�K.�d <br />ARCHITECT O�ESI TER <br />MAIL ADDRESS <br />zln <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />zip <br />PHONE <br />LICENSE . <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />LICENSE , <br />rI\LI ITA AAG n,. M6. I/_ <br />A.,A I"7P,.\L,.. 7117f Q_0 <br />1, 11 e I,♦ <br />D.-Iq -I,-11 <br />fen_7-]� <br />.., .. ...,-_. <br />C NEW ❑ ADDITION <br />VALUATION OF WORK (COST OF 1.1, <br />oo 0,. Eq 0 <br />ALTERATION ❑ REPAIR ❑ DEMOLIIION ❑ WOODSTOVFmRPI INSF(TT n <br />DESCAIHC WORK <br />Am (ill->F ' r,\c, �;,C_ AMw---O <br />USE OF BUILDING <br />KID r - t 'G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING 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 />SIGNAWFCO,(RACTO/ROO 4T HTHOIBZEDD,AAGGENNF�T DATE <br />LEGAL OESCRIPTION OFP 4OPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK __OF— <br />PROJECT ADDRESS <br />9 Leo l ��✓��I�_�a,x <br />APFFLICANTS CITY BU. SS LICENSE NO <br />a 0 0 0 8 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOU!PMENT <br />FfOE <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 />BOILERS - 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 />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESDRI'ERS <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 (SERVICE -BAR, ETC.) <br />METAL FIREPLACE f CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />727 <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FPONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTADEA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S75 <br />_ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING @U <br />PLUMBING <br />SIZE OF BLOB <br />NO OF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATIONACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />