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PLICATION FOl', <br />BY <br />CITY OF <br />T I O N <br />CONSTRUCTIONC O NPERMIT <br />everett <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />,i <br />❑ DEMOLITION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />*SIGN <br />OWNER <br />- L/JU�'AL (�DAR- NOtiIES <br />MAIL ADDRESS CITY ZIP <br />�E 6 E VE'QU(1£r�1 � cyy, c� yEl?x-TT <br />PHONE <br />ARCHITECTOR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL AOCRESS CITY ZIP <br />� IJ4L2/02. E:Lc`CJT, OG/, ,(%GiI /.lf', r sT T <br />� l�'l lei �/(-T /JI--,V�• 1?_E!�/UO/✓G �%�'��.c- <br />PHONE <br />��/-U<<J/ <br />LICENSE• <br />SuyE�c'Ary7,/A.t <br />I <br />I MECHANICAL CONTRACTOq <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR MAILADDREFS CITY ZIP PHONE LICENSE <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK <br />/4).S_r&.L, / Rz /NTL��IUQL (ct.ur�• 'f/UL:E ;r��/ S ein xz�'o,,�, <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNCW THE SAMETO BETRUEAND 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 GRAN. iNGOFAPERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR TH RFORMANCE OF CONSTRUCTION. <br />„GNA RE F CONTRACTOR O AUTHO IZED A ENT DATE <br />xD <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT —BLOCK OF <br />PROJECT ADDRESS <br />�(oOQI EI/Ecoiii ao lrt//4cI <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />/Fi,_-B(,2 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILET) <br />• <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />I CLOTHES DRYERS <br />URINAI <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 />HOOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />BUS TOTAL <br />SUB TOTAL 3 <br />PERMIT f <br />_ <br />PERMIT f <br />_ <br />TOTALFEE IiII <br />TOTALFEE 3 <br />TYPE OF <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK <br />LOT AREA <br />OCCUPANCY GROUT <br />N0. OF STORIES <br />iED ❑ YES ❑ <br />VACANT SITE <br />OYES ONO <br />MAX. OCC. LOAD <br />APPLICATION ACC. BY PLANS CHECKED BY APPR/FFOORIRR IS! <br />/r <br />FEE RECEIPT ) <br />FEES VALUATION FEE <br />BUILDING 3 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />FENALTY <br />TOTAL <br />