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i �l1 » i ''?P 9.rt ?I *' i ,91 I 1 <br />o. <br />cry OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />�►''PPLICATION FOB <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION O COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING O SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS Of WORK <br />❑ NEW ❑ ADDITION El ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ 'NOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION Of WORK (COST Of MATERIALS PLUS LABORI <br />/r 700 �— <br />DESCRIBE WORK <br />_ i».. A, . <br />USE OF SUILDING <br />•O a.. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOWTHESAME TOBETRUF.ANDCORRECT. AL:. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPL' <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 JP <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. ' <br />SIGNATURE OF CONTRACTOR OP AUTHORIZED AGENT DATE <br />X _C jr i?,, <br />LEGAL DESCRIPTION OF PAOPERTYISHOWNBELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK OF <br />PROJECT ADDRESS <br />WG ?(L�r�c/t/ac <br />PLUMBING <br />AP FICA TB CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />/ <br />WATER CLOSET TOILET) <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY IWASH BASINI <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK & 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 />_ <br />_ <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 />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />IE <br />All - <br />SUB TOTAL <br />q <br />SUBTOTAL S <br />PERMIT S <br />PERMIT B <br />TOTAL FEE • <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />USE ZONE LOT AREA VACANT SITE <br />FEES VALUATION FEE <br />OYES ONO <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING UNITS _ <br />BUILDING <br />SIZE OF BLDG NO OF STORIES MAX OCC. LOAD <br />PLUMBING L <br />MECHANICAL _ <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />OTHER <br />PENALTY <br />APPLICATION ACC BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />L- � TOTAL <br />