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APPLICATION F06. <br />OF CONSTRUCTION IYBEB" <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />)(DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />7� MAIL ADDRESS CITY ZIP PHONE <br />11moajL, Oi 1- �o ✓t /� /� 0 ? .�� d B /ii2i�i a.LJy All; 9l'oj-3 F; ,?-07,97 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />DENERAL GONTRACIOR / MAIL ADDRESS CITY ZIP PrIONE LICENSE <br />(��o� liFlrL LOTUS?J[ucTYoA1 %� 5303 �he1PIc��AA(f#a76 F(F� qE42y 8-ii4v�7 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHO ICENS <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />LLLUATION OF WORK ICOBT OF MATERIALS PLUS LABOR) <br />DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK <br />✓ We DawL) 84 p is C7` FOUL- 4461663M..IG FILL Co✓E-R W/rLe0SHtJ--,, ICt7C'k- /GU6455� <br />i <br />,I <br />I <br />i <br />I <br />USE OF BUILDING <br />fZ <br />Out S 1a tzAfi Utlt ?wyo' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. 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 />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />�CONTRACTOR OR AUTHORIZED AGENT DATE <br />SSIIG�NAA.T}{URRE� OF <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWORATTACH FOURCOFT` <br />LOT —BLOCK 0 <br />__ 11 <br />$E� A <z he rc�o P�/�J <br />PROJECT ADDRE38 <br />�+/ , e FtOr'itAc 37 vl O/f/ , f. <br />Ave, . T7 11 <br />APPLICAN TS 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 />ATC - AJMNOLG UNITS - M.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 f 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 f CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />BUS TOTAL <br />f <br />!ll <br />SUBTOTAL <br />PERMIT <br />f <br />'R <br />PERMIT <br />TOTALFEE <br />f <br />.TOTALFEE <br />PLAN CHECK NUMBERS <br />FEE <br />RECEIPT NO. ' <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWFLLINO UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />Jar <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />[ <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE HESPONSIULE FOR DETERMINING ALL <br />nA�^`M � �L /1�p,�P� �_ q_ of PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />