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the EFOrgrpR r PPLICATION FOh <br />CITY OF ..:[CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL N PLUMBING <br />❑ SIGN <br />OWNER <br />I�eT t i iau(Y{ <br />MAIL ADD RE ITS CITY <br />Z 15 SW E,S,eFTT rv�qu �u <br />ZIP <br />�r,,���rr <br />PHONE <br />�AIA- <br />ARCHITECT 0gDESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PNONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP P1/01:E LICENSE• <br />PLUMBING CONTRACTOR <br />�1D2nIwc�T F-L l,ty <br />MAIL ADDRESS <br />SySiGvvts ax dvZc)bI5-52,-" <br />CITY ZIP PHONE LICENSE• <br />A09 W. i_LF,Aa. -OL)o 1�q �lY�y36a <br />CLASS OF WORK <br />19 NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORKICOST OF MATERIALS PLUS LABOR) <br />USE �OF..�BU�ILDING <br />Rp=I T11( AO TU <br />Nfl <br />I HEREBY CERTIFY JfH <br />I HAVE READ AND EXAMINED THIS AP- <br />N <br />S <br />PLICAI ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 7/r <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK o <br />PROJECT ADDRESS <br />Z 15 - Ste/ &a-i . AAA-) +._ \uA <br />PLUMBING <br />MECHANICAL <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYIUIPMENT <br />FEE <br />CLOSET (TOILET) <br />AIR COND. UNITA. <br />REFRIGERATIOH.P. EA. <br />WASH BASIN) <br />"DISHWASHER <br />GAS FIRED A0. ONNAGE EA <br />NKS DISP.FORCED <br />AIR SY.T.U. M EA.R <br />WALL HEATERSM <br />RAY <br />MirlBOILERS—H.P. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <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 />_ <br />METAL FIREPLACE & CHIMNEY <br />SINK(SERVICE—BAR. ETC.)WOODS <br />OVElFI EPLACE N :RT <br />SUBTOTAL <br />E- <br />'~ <br />SUBTOTAL S <br />G <br />PERMIT $ <br />PERMIT S <br />i <br />TOTAL FEE $ <br />�- 1 <br />TOTALFEE 3 <br />-7 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />-NOU1 SLIUAC.K .IIILn113CIpACH <br />USEZONE ILOT <br />TYPE OFCONST. I OCCUPANCY GROUP <br />SIZE OF BLDO. I N0. Of STORIES <br />ON ACC BY <br />PLANS <br />�l <br />-... _...- ._ . _ ._.. <br />CIICCK NUMOEN I � PLAN CHECK fCF <br />FEE IRECEIPT NO. <br />VACANT SITE FEES VALUATION FEE <br />OYES ONO <br />TELLING UNITS <br />BUILDING <br />LOAD <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />ISSUANCE BY <br />TOTAL <br />