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,B,E,,,,,R i`-IPPLICATION f0i <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑COMBINATION )aBUILDING ❑ MECHANICAL <br />4 OWNERt' / MAIL ADDRESS CITY ZIP <br />•o * iJr� 4 �JA9 G�AeFF /7�s� 7 SP! Sr. TIC-�IF�� G,in/ ; <br />i ARCH I TECT OR DESIGNER MAR ADDRESS CITY ZIP <br />�on/treC�cJZ <br />GENERAL CONTRACTOR � MAIL <br />ADDRESS CITY /.ZIP <br />� iA.W fre�/OA��lM71Nr. o[Ie/S 1.1 C,01/Na .iui;Ar .3 F Cvf+t'+V l�N <br />PLUMBING CONTRACTOR MAIL ADDRESS Cltt ZIP <br />❑ PLUMBING ❑ SIGN <br />7- 3r3-9 7/a <br />- LCENSE <br />J6cls,7 l*lc <br />LICENSE A i <br />LICENSE A <br />0 NEW __ ❑ ADDITION ❑'ALTERATION ❑ REP, IR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATI OF WORKICOST OF MATERIALS PLULABO <br />� S P <br />A a�� <br />DESCRIBE WORIt I c ___ <br />/1/E'A••/ �S/ vl/. L <br />USE OF r:URDINo <br />SJ'S/E 6•.�� .egSs-r +TN� <br />I HEREBY :IERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIORAND KNOWTriSSAME TOBETRUEANDCORRECT. ALL <br />PRO",:,iONSOFLAWSAND09DINANCESGOVERNING THISTYPE <br />OF I VORK 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 Or <br />ANY OTHER STATE OR LOCAL LAW REG TING CONSTRUCTION <br />OR THE PERFORMANCE OF CONST TION. <br />SIONATURE OF CONTV6TOR OR AUTHID D AGENT DATE <br />/0-�-86 <br />X <br />L I EGAL OMCRIPTIONOFPROFE (SHOWN BELOW OR ATTACH FOUR COPIES) <br />% <br />LOT-fL—BLOCIL_OF <br />G EMOQTC ' <br />`or/-"//.J< a?/ /6 <br />PNUiCCT ADDRESS <br />APP ITY USINESSLICENSENOO.`� <br />PLUMBING <br />_ _ <br />MECHANICAL <br />'No <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE O- EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) _ <br />AIR COND. UNITS—HEA <br />I <br />BATHTUB <br />/S <br />CID <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />co <br />BOILERS-H.P. EA. <br />S.:OWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK f DISP. <br />CD <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 />5 <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />WAT-6 <br />URINAL <br />- <br />VENTILATION FAN <br />3 <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />- <br />METAL FIREP'.A E f CHIMNEY <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPLACE <br />INSERT <br />O <br />Ir5 <br />fit <br />3 <br />D <br />I' <br />SUB TOTAL <br />SUBTOTAL f <br />PERMIT f <br />' 'PENFAIT f <br />TOTALFEE f <br />TOTAL FEE f <br />J <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />IA ' •• <br />REAR SETBACK <br />.O <br />SIDE SETBACK <br />-1.S <br />PLAN CHECK NUMBER <br />�/ <br />PLAN <br />FEE3yra9s <br />CHECK FEE <br />RECEIPT NO. �Qla1 <br />Q ( 7 <br />USE ZONE . <br />'I� 9i5 <br />LOTAREA. <br />— <br />VACANT) SITE <br />QYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />Dul:omc <br />sFO7��l <br />�y <br />,FB(RjEQO,F BLoDO. ^ �A <br />GO IV M� �i IV �1-I <br />I:J. UP STORTS <br />'Y �US. <br />MAX OCC LOAD <br />— <br />-LUMBIt.G <br />�r�ff <br />OD <br />FIRE SPRINKLER:. REOUIRFD OYES IV NO <br />MECHANICAL <br />M <br />JC <br />OTHER <br />PENALTY <br />TOTAL <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />L G •, <br />