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-'.,PPLICATION"SO. <br />tile Ewrgmn <br />- <br />QVCTBN <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />P+ <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION P3•BUILDING E -MECHANICAL . <br />15-PLUMBING <br />21 SIGN <br />OWNER n <br />Le16ui-7 I'�'f II�1�/S <br />MAIL ADDRESS CITY ZIP <br />7i(o S-e <br />PHONE <br />C-Vi5-2t=f- ik. A uti , Evc��tt_ <br />4��4 347 <br />�s'v.5 <br />AR//CHITT�E��CTT/ OR DESIGNER <br />MAIL ADDRESS � ZIP <br />PHONE <br />y�TlLllV 1'M7?%. tAI ScI•J <br />nCITY <br />ILZ% I.L•�_�LC.7�-L n�.Z• <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />CITY <br />PHONE <br />LICENSE• <br />-]i�L{OLT�'t� 41nLa]�7 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PIIONE <br />LICI'NSE. <br />CLASS OF WORK <br />9 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />A17� O(^.t�5114" <br />DCSCRIBE ORK <br />CGY_/j71-/_ e n <br />5(Te LD.v2K l-_.?!>D I al �:� <br />S! /�..Ion� 11�, I ��r,.--c rJ. � <br />_.t <br />. _ - -- __."__•_- <br />USE OF BUILDING <br />j iflNDA vLLta�c {c[� 1 S7zY) hTV <br />.. .. ..-._, w.A .���•v Gam. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE P FORMggICE OF STRUCTION. <br />SIG rE CONTRAF1 R OR THU IIZE7 NT DATE <br />APPLICANTS CITY BUSINE LICENSE NO. <br />LEGAL O FS17,191PTInli OF PROPERTYSHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK _O <br />��/ <br />PP n lI n P IY .j <br />PROJECTADDRESS <br />cQ 15 s GS cVL--7zLs VLl A-1.>_, L, a. 'Fv _ a <br />PLUMBING <br />MECHANICAL <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />EQUIPMENTFFEE <br />WATER CLOSET (TOILET) <br />I <br />AIR COND. UN. EA.BATHTUB <br />REFRIGERATIS-H. P. EA.LAVATORV(WASH <br />BASIN) <br />BOILERS-H.SHOWER <br />MEQUIPMENT <br />GAS FIRED A -TONNAGE EAKITCHEN <br />SINK& DISP. <br />FORCED AIR -B.T.U. M EA.DISHWASHER <br />WALL HEATER. MLAUNDRYTRAY <br />UNIT HEATERMCLOTHES <br />WASHER <br />EVAPORATIVES <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT f <br />TOTALFEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />TYPE OF COf T. <br />' SIZE OF BLDG <br />2o, Z zo <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />m- i0 <br />46- <br />I <br />L G. <br />I <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK <br />+9- <br />S1DE SETBACK <br />Z.l- <br />PLAN CHECK NUMBER <br />O / ���' <br />Q <br />PLAN <br />FEE / L`(0� <br />-N <br />CHECK FEE <br />RECEIPTNI <br />LOTAREA <br />3, �� 1 <br />VA ES No <br />FEES <br />VALUATION <br />OCCUPANCY GROUP <br />v - Z <br />NO. OF DWELLINGUNITS <br />V <br />BUILDING <br />SS��L� <br />L <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE <br />I <br />