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All <br />the EwrgFMn .APPLICATION FOi. _ w <br />CITYOF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS j,,W-/d i. r96Ta.0 CITY ZIP PHONE <br />/?Ct. t."%� �Altf✓_/ /n/Gr.. _/ r _ /(' i NNr..rt-e t� 949 e'7 77/-9%Y.3 <br />ARCHITECT OR DESIGNER MAIL ADD ESS -7 T CITY ZIP PHONE <br />�lQ_Uya,.•r •' ?l ri Sur l3<•r Il - rr Q7s/9 __/-9Y/-3C71-aYL-dnY:i <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE( <br />LS'/. �•o.a J//' c/i .l t a-, 4 ?4 Y � J.. oT Nu., 7f„l ut ✓ � C D42- L,S.7 • G� c-a .SILVAsf 1710•y <br />CLASS OF WORK <br />YWNFW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />ra <br />i R <br />usEo BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 'I HIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ��' /c <br />eEIESyAL DESCRIPTION OF PROPERTY BELOW OR ATTACH FOUR COP( <br />Pi <br />LO'�OBLOCK_—OF ''' <br />PROJECT ADDRESS <br />APPLICANTS CI TY BUSINEB ENSE NO. <br />PLUMBING - <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <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 />• <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />00 <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />4.00 <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />iii'. <br />UNIT HEATERS-B.T.U. M <br />y <br />CLOTHES WASHER <br />IVE COOLERS <br />WATER HEATER <br />DRYERSURINAL <br />ION FANDRINKING <br />FOUNTAIN <br />ODFLOOR <br />DRAIN <br />ULTHESDRYERS <br />LING UNIT- C.F.M. <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />EPLACESSINK <br />SERVICE -BAR. ETC. <br />VE/FIREPLACE INSERT <br />SU_D TOTAL <br />SUB TOTAL f <br />PERMIT B <br />PERMIT = <br />TOTALFEE 3 <br />a <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SE70AACK <br />'2^-� • <br />WEAR —SETBACK <br />(�©�� <br />SIDE SETBACK+ <br />r <br />PLAN CHECA NUMBER <br />(�� / /.YJ�D <br />LAN <br />FEE 2 <br />CHECK FEE p' <br />RECEIP�OC,D / <br />J <br />USE ZONEy�� <br />'L ? 2 <br />LOT AREA <br />VACANT SITE <br />ISfr$ ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CCONllST11. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S 81 <br />3 <br />SIZE OF BLDG <br />1716 y. F, <br />NOOFSTORIES <br />1 + ✓r �� <br />MAX. OCC. LOAD <br />PLUMBING <br />■ <br />r <br />FIRE SPRINKLERS REQUIRED ❑ YES NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />f 8. <br />PLANS CHECKED BY <br />k�W In <br />APPR FOR ISSUANCE BY <br />TOTAL <br />�� <br />C <br />15;rr um_t. cnw...LoT PP-oj�r I►rro <br />mowrv'ISIA� Yam• <br />�m <br />N m <br />m <br />co <br />m o <br />C <br />O 3 <br />m <br />rn ZH <br />m <br />.0 2 <br />r 2 <br />Ln <br />O A <br />n D <br />m <br />-� m <br />2 <br />M <br />N <br />o m <br />c-T m <br />C= N <br />N <br />m <br />- m <br />• m <br />a <br />r <br />