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XPLICATION FO._' vi <br />CITE""°`"" <br />CITY OF CONSTRUCTION everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATIC H ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAR ADDRESS ZIP PHONE <br />TER CITY <br />77 <br />/�r�7 6,nAe.I L? '.(I IA//11/ Y%J!'./A 14411 <br />ARCHITECT OR OE910NER MAID DRESS v CItY .� <br />:ENERAL CONiRAC10R MAIL ADDRE99 ZIP PHONE UC 9E• <br />/ i, /1Y elrlL� -,, - <br />•AECMANICAL CONTRACTOq <br />MAILADDRES9 CITY ZIP PHONE LICENSE <br />PLUMlINO COMPACTOR <br />MAIL ADCRElll CITY lIP INTONE LICE NINE • <br />LAS90F WORN I.y( <br />yq REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ' ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION El ALTERATIOf <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUE 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 />LV In vinl ATF OR CANCFI. THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZ ED GENT DATE <br />X <br />✓LG'll <br />APPLICAN <br />T9 CITY BUSINESS LICENSE NO. <br />PROJECT <br />ADDRESS <br />'>6 )0 <br />5,v(I <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />__ <br />AIR COND. UNITS-H P. EA. <br />WATER CLOSET (TOILETI <br />REFRIGERATION UNITS-H.P. EA, <br />BATHTUB <br />UOILERS-H. P. EA. <br />LAVATORY IWASH BASINI <br />GAS FIRED AC. UNITS -TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />KITCHEN SINK & DISP. <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />RAINS-RAINLEADERS <br />WOODSTOVE/FIRCPLACE INSERT <br />ERVICE-BAR ETCI <br />ISINK <br />S <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT II <br />PERMIT IT <br />TOTAL FEE S <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSUNNLL <br />FRONT SETBACK <br />REAR SETBACK <br />910E SETBACK <br />PLFN <br />fEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOI AREA <br />VACANT SITEFEESVALUATION <br />ONO <br />-M <br />jCIll'ECKMBER <br />TYPE OF CONSi. <br />OCCUPUICY GROUP <br />NO.OF DWELLING UNITS <br />51ZE OF BLOG. <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS RECUIRED U YES O NO <br />MECHANICAL <br />4FEEOYES <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />PLANSLIIECKED EV <br />APPR.FOR ISSUANCE BV <br />TOTAL <br />