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Nu Ewrprrwn <br />1 CITY OF <br />everett <br />I <br />I <br />I <br />I <br />I <br />1? <br />T � `",l <br />A'PLICATION FOR`- <br />CONSTRUCTION e <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />Tl '��/S,L2'Ai/.1' <br />/iICY/!�`- Si <br />�%/�Y/� <br />%c^�iy?iff-L5/' <br />7� [ = -/if��-3lri-q�. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />T CITY <br />ZIP PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />ji NEWV^ ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLU5 LABOR) <br />%�� <br />DESCRIBE WORK i�/S77`fLL s uc .l.TrniMz7� /P��/T/�ivc� v/7 7`sz/ �crvi rr�z� <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTH E SAME TO BE TRUE AND CORPLCT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 PTiC)VI.SIONS OF <br />ANY OT' IER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF 50 <br />W ACTOR OR AUTHORIZED AGENT DATE �p <br />LEGAL DESCRIPTION OF PROPER"(5HOWN BELOW OR ATTACH FOUR COPIES) <br />LOT -BLOCK ­OF <br />- <br />PROJECT ADDRESS <br />APPLICANTS CITY 8 WIGSS CHMENSENO. <br />PLUMBING <br />MECHANICAL _ <br />.- <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSETITOILETj _ <br />AIR COND. UNITS—H.P. EA <br />'IL <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY WASH BASIN) <br />BOILERS-H.P. EA, <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A 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 />_ <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—RAINLEADFRS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE --BAR ETC. <br />WOODSTOVEIFIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT It <br />PERMIT S <br />TOTALFEE ! <br />TOTALFEE 6 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING <br />_ <br />BUILDING <br />BLDG. <br />NO. OF STORIES <br />MA%. OCO LOAD <br />PLUMBING <br />SPRINKLERS REQUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />1TION ACC, BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />MBER PLAN CHECK FEE <br />FEE RECEIPT NO, <br />FEES I VALUATION FEE <br />E <br />