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the EwrpTNn <br />CITY OF <br />everett <br />BUILDING DEPT. <br />259.8745 <br />r1111 <br />APPLICATION FOR <br />CONPERMITTION <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ Pl ltuwlMr_ fl mr_u <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE+ <br />!�E'LA4 At1Tf. �A1NUSrKIp) pD Box '( <br />MEC A nk]T.1/6 EVC2crt 983e1 3iY 8)yi BEUUAI IS9C0 <br />CITY ZIP PHONE LICENSE+ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORN )COST OF MATERIALS PLUS LABOR)-APMPIrF• <br />seo /Cb r0o-vim <br />DESCRIBE WO K <br />�IOA l47-l��r T— G14 seGU ,Q r. r <br />USE OF BUILDING - -- <br />REG CFn7 rFZ <br />-- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />THE GANTING OF TDOES NOTPRESUME TO <br />GI ERAUTHORITY TO VIO VIOLATE OR CANI CELL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONS UCTION. <br />SIGNATURE OF CONTRACTOR OR UTHORIZ D AGENT DATE <br />APPLICANrSCITY BUSINESS LICEN <br />LEGAL DESCRIPTONOFPROPERTYISHOWNBELOWORATTACHFOURCOPIESI <br />/ <br />Lo eLocl`_oF IDS- <br />lNOT <br />h O,v Ja AJ fiXX2 <br />C e v'T- <br />PROJECT <br />-g//S ``77 ��__''` __ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURO <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET OTC <br />.414 <br />AIR COND.UNITS-H.P. EA. <br />BATHTUB 41 <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) '7 <br />BOILERS-H.P. EA. <br />SHOWER . <br />KITCHEN SINK & DISP. <br />/ <br />GAS FIRED AC. UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B.T.U. M EA. /p0O aj <br />DISHWASHER <br />ev <br />1VALL 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 />HOOD <br />FLOOR DRAIN ___jRANGE <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />I <br />Lam:' <br />SUB TOTAL s <br />PERMIT f <br />PERMIT $ <br />TOTALFEE f <br />TOTALFEE OR <br />(� <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'HUNT 5EIBAGK <br />REAR SETBACK <br />USEZONE <br />LOT AREA <br />%'RD <br />15 425o <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />z'—rJ <br />A -3 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />Z81c. sF EA. rtlz <br />! +Past <br />VFLIUAIIUNACU. BY <br />PLANS CHECKED BY <br />ST� <br />Jer- <br />VACANT SITE <br />'YES ONO <br />NO. OF DWELLING UNITS <br />BUILDING <br />_ <br />MAX. OCC. LOAD <br />I� \ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />/✓' IFEEc Z _ 3U REC �Q. / <br />FEES I VALUATION I FEE <br />/pc✓. <br />oAfeo <br />//71-gS- <br />N2e� <br />of <br />�czTx� <br />r89 <br />