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the EwrUMn <br />(— CITY OF <br />everett <br />BUILDING DEPT. <br />259.8745 <br />.rl.t.. �.TY.'.1�•-:.YT�H'•: l.:n"l• .Nl.wlwn..n.... .•.a,..... <br />j <br />APPLICATION FOK evereN <br />CONSTRUCTION e <br />PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />kCOMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL ADDRESS <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />Cltt <br />21P <br />PHONE <br />LICENSE <br />S*X-c- <br />_ <br />MECHANICAL CONTRACTO.1 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSre <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />Cltt <br />ZIP <br />PHONE <br />LICENSE <br />CI.A OF WORK�y M �T ,sq <br />NEW Iq ADDITION 9 ALTERATION K REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK(COST OF MATERIALS PLUS LABOR) "• <br />nrRnmRPwnnk -38n NCA:.J17/TI`ca/�,�R�'.e wc�c ,v('/e//•e/niww <br />T, _ J �J_.;...� .rn n... /..lf L,..:.1.. •.Y.nT.A� �^c0 4 w.1fETf, �F/wL.7�+ � vs-�, GnccrcvC,c/ewr! J rc'��c( Yo .1r�MY++''. <br />USE OFB INO <br />C-8 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION ANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />f. F WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />,N OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEI. THE PROVISIONS OF' <br />ANY OTHER STATE OR LOCAL LAW REG J; ATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CO TRAC R OR AUTHORIZED AGENT DATE <br />v <br />LEGAL DESCRIPTION OF PROPERTYIS WN BELO-' OR ATTACH FOUR COPIES) <br />7.12/�, <br />LOT— BLOCK-LDF <br />�p T <br />y e•(_�� �� /Jr• J/' �1?✓d•Id i - <br />/C /T <br />PROJECT ADDRESS <br />0/i I , "51 � w 'veal <br />APPLICANTS CITY BIJSINESS 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 -TONNAGE EA <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER _ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />ISTOVE _ <br />ROOF DRAIN--RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />� r„•_ <br />WOODSTOVE/FIREPLACE INSERT <br />!J P/Q <br />� <br />SUB TOTAL <br />SUB TOTAL 3 <br />l% <br />PERMIT $ <br />PERMIT S <br />I TOTALFEE f <br />1 <br />1 <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK <br />I / iT I / /' _ / i � r— h/ FEE -i �� I RESCII <br />V <br />,ACDIJ 3i"1 S <br />DYES AD <br />'TPANoCCY GROUP <br />^3 <br />NO, OF DWELLING UNITS <br />I <br />BUILDING <br />OF STORIES <br />MAX. OCG. LOAD <br />hll� <br />PLUMBING <br />LS <br />� � <br />) ❑YES drNO <br />MECHANICAL <br />y <br />OTHER <br />PENALTY <br />TOTAL <br />NS CHECKED BY <br />APPEL FOR ISSUANCE BY <br />FEES 3 /- <br />FEES VALUATION <br />S <br />FEE <br />U 0_0 <br />% J0 <br />/Lq,3Iv <br />2 <br />O <br />--1 <br />m <br />m <br />Hm <br />cv <br />Tn Q <br />O 3 <br />rn <br />m� <br />O z <br />CZ <br />p•I M <br />T <br />O 3 <br />=m <br />m.. <br />N <br />or <br />Crm <br />fA <br />ic rrn In <br />zn <br />-1rn <br />• m <br />a <br />a <br />z <br />0 <br />«. <br />m <br />m <br />