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`APPLICATION F���t <br />CITY OF CITECONSTRUCTION <br />OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED 114 INK- PLEASE PRINT <br />DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />*553oo 3 �Y o Ws..-1 t�VI ePozo4 353 ~ 1119 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR MAIL ADDHESi CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRAC IOR MAILADDNESS CITY ZIP PHONE LICENSE IT <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR l5dDEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />PLUS LABOR) <br />DE�SYCRIBE WORK <br />I/Ac,MA ri <br />USE <br />{{GFeuILOI. <br />LYLWI. 4U%1%%'>V�-f�') <br />1 HERBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTH 9 SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOFLAWSANUORDINANCES 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 AUTHORIIY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOT TATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR T PER MAIJC CONSTRUCTION. <br />SIGN TURE OF ON RACTO OR AU HO D AGENT DATE <br />L_ <br />1i�19,& G <br />LEGAL D pPTIONOFPROPERTY(SHOWNBELOWORATTACHFOURCOPIES) <br />LOT- BLOCK _0 <br />PROJECT ADDRESS <br />9o00 t�Y/ITTt_e-PL63� i�� z <br />APPLIC iS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <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 AC, UNITS-TONNA 3E EA <br />KITCHEN SINK & DISP. <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <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 />_ <br />FLOOR DRAIN <br />_ <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 />_ <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT _ f <br />PERMIT f <br />_ <br />TOTAL FSE fI <br />I <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />F KONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />f <br />SIZE OF BLDQ <br />NO. OF STORIES <br />MAXOCG. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />gPPR. FOR ISSUANCE BY <br />TOTAL <br />I <br />o <br />