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OPLICATION FOh1, <br />CITY E�ro" " <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />yw 1 <br />7 So4T <br />n <br />P' <br />MAIL ADDRESS CITY ZIP <br />d73/ Fl- Je_ l Eve <br />PHONE <br />.5 l✓ <br />If-6le-A• N <br />.79A //7J4 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />I <br />- GENERAL CONTRACTOR <br />X_Zd.e.k <br />I '� <br />MAIL ADDRESS CITY <br />/ ZIP <br />�edeCO,� r2rc7l <br />PHONE LICENSE <br />r' Johnslay_ <br />' <br />737 9sZoi <br />//�9 <br />I . MECHANICAL CONT FACTOR <br />AI <br />MAIL ADDRESS Cltt ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />Ir <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE• <br />1ll <br />BE <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT _x BUILDING RELOCATION <br />(ALUATION Of WORK (COST OF MATERIALS PLUS LABORI <br />��EqDESCC�RIBE WORK LL <br />/QP_'n[P w'{ P_ P_YZ S/ ; AIA Zn / /_ 7`/„ <br />US OF BUILOtNO <br />}t�•1.�-0 II <br />/�LA.Ir Wnrel�oL.sC_ <br />V R • <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OFWORK WILL BECOMPLETED 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 PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF ONSTRUCTION. <br />SS TI1RE OF CONT ACTOR O HO ED AGENT DATE <br />LEGAL DESCRIPTION � OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />d-�(p I.I 1/1 < <br />L BLOC OF <br />1. <br />PROJECT ADDRESS <br />( 027 3 / `ti jciz-0 <br />1^ <br />L vcre7l- <br />APPLICANrS CI IN SS LICENSE NO <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/HNDLO UNITS - H.P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. 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 />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GA.S PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />31 <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$/Q��Qp <br />, <br />TYPE OF LONST <br />OCCUPANCY GROUP <br />/3 - 2 <br />NO. OF DWELLING UNITS <br />••JJ6� <br />PLUMBING <br />SIZE OF BL00 <br />/(,:zO <br />NO OF STORIES <br />/ <br />MAX. OCC LOAD <br />/vIll <br />MECHANICAL <br />FOd�1/j7,�JjQ/� <br />FIRE SPRINKLERS REQUIRED ❑ YES YNO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANSOHELKEO BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS 1 <br />i. <br />TOTAL a <br />PROPERTY OWNERS MORES ONSIBLE AND <br />EASEMENTS. <br />ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />*3VAZ Ad&7&9671041 <br />