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FM EwrprMR <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />❑ DEMOLITION <br />Aj <br />.:APPLICATION FO.-d' <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ COMBINATION ❑ BUILDING <br />MAIL ADORE SS <br />❑ MECHANICAL ❑ PLUMBING <br />ZIP PNUNE <br />1=�11 PFTi 9�aa3 35S- <br />❑ SIGN <br />MAIL AGGRESS <br />GTV ZIP PHONE <br />LICENSE <br />GENERAL CONTRACTOR <br />CI1V ZIP PIlONC <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MML ADORES'+ <br />CITY ZIP PHONE <br />LICENSE <br />PLUMBING CONIRAGtOR <br />MAIL ADDRESS <br />CLASS OF WORN <br />❑ ❑ REPAIR ❑ DEMOLITION\NOODSTOVE/F RPL.INSE Ri ❑ BUILDING RELOCATION <br />NEW ❑ ADDITION ALTERATION <br />VUAR01! DF wofiK lco9t GF IAAN nu15I'LLIS LABOnII <br />70 CLAY LrNriR MogItIC WNW <br />DESCRIBE WORN <br />7�A5>r4uelvEc: <br />r_ — .n. r �a iT wi•_ /'UinAiAV L/)� In mNwlGTi/f/ <br />hV,5 _& CLAYLAfi'�/C r�- <br />USEOFBUILDING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />��j t <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />or PROPCnTVISIIOWN BELOW OR ATTACH FOUR COrl"I <br />LEGAL OEScn,py, <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_BLOCK_—OF_ <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 lc <br />eu <br />APPLICANTS <br />CITY B oINESS LICENSE NO. <br />PROJECT <br />AGGRESS <br />&oz(o <br />i <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />ENT <br />FEE <br />NO. <br />AIR COND. U <br />COND. <br />WATER CLOSET (TOILET) <br />EEM <br />BATHTUB <br />_REFRIGERATEA. <br />DOILE <br />LAVATORY(WASH BASIN) <br />GAS FIRED AC. UNITS -AGE EA. <br />SHOWER <br />FORCED AIR SYSTEMS. M EA.DISHWASHER <br />KITCHEN SINK 8 DISP. <br />_ <br />WALL HEATERS-B.T.U._LAUNDRYTRAV <br />UN ITHEATERS-B.T.U. <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />FLOOR DRAIN <br />BREAKERS <br />STOVE <br />_ <br />_VACUUM <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />WOODSTOVE/FIREPLACE INSERT <br />SINK(SERVICE-BAR EIC_L� <br />_ <br />_ <br />SUB TOTAL 8 <br />._ <br />SUB TOTAL <br />PERMIT S <br />PERMIT It <br />S <br />TOTALFEE 1 <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />F ITONI SEiDALK <br />(RAN SB IDACK <br />SIDE SETBACK <br />PLAN CHECK NUMBED <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOt AOEA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />-- <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED IT YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC By <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />