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I iPPLICATION FO' <br />CI EO'°'"" CONSTRUCTION <br />everett PERMIT <br />i BUILDING DEPARTMENT TO BE COMPLETED IN INK PLEASE PRINT <br />i <br />259.8810 <br />DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OjWN � MAIL ADDRESS CITY ZIP <br />ARCHITECTOADESIGNEH MAILADDRESS CITY ZIP <br />❑ PLUMBING <br />❑ SIGN <br />GENERAL CONTRACTOR / MAIL AUUNtSS /1 n <br />��oC �iF1rE L l� CucTIOAJ 1AJQ_ 5303 p&cF (FT[� L/c a76 F(E q842N e3 1v2r <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP �o-'EJ-Ae-xsq J? rlc,o7;)pp <br />j PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE c <br />CLASS OF WORK <br />I ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />'1 ......... ......c wnou ,T nFMAtFRULS PLUS LABORI <br />DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK F� T X r8.. � r 1T n <br />'✓ Lha �Dw..� IdI.DFiS - n` - - TA_..in_ BncIC r!(-L- Coucrf! w/i'EZUSHtJ--"` O� ��p/(,C <br />USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHESAME TOBETRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTYISHOWNBELOWORATTACIIFOURCOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />•� V/ OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT- BLOCK OF IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />$FIt Ali Ac FTcp, ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />J SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />L' <br />E: <br />PROJECT ADDRESS - <br />�t'I -, e Fr'oewt?l s v` n�r� F f. �,� - c. Ty <br />APPLICANTS CITY BUSINESS LICENSE NO <br />/ 9 3 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — N.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.U./H.P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK S DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />[Aj" <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />},' <br />h <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE f CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTALFEE fI <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONTSETBACK <br />REAR SEACK. <br />TB <br />SIDE SETBACK <br />USEZONE <br />LC_ ITAREq <br />VACANT SITE <br />AYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF OWFLLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MA% OCC TOAD <br />MECHANICAL <br />OTHER <br />Is <br />FIRE SPRINKLERS REQUIRED DYES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY I <br />PLANS C!IECKEp BY <br />gPPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAI <br />A <br />IIA_- <br />nr rucRc noc ooconkmint E EnR DETERMINING ALM <br />nA A z y PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />