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I �P `A <br />TA. EY.rpFgA kOPLICATION FOR` <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK!- PLEASE PRINT <br />❑ DEMOLITION P9 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP Punur <br />MEiPj NICA 00 RA/C,TOR / MAIL ADDRESS C/CITY ZIP PHONE ��L �D LICENSEG 4 <br />/'uw.�- flPi.Tt/M•C llD3-/27�,V.f• Lod._ �lu�A,S PBzr6 33y-y��,/ - <br />PLUMDAGCONTRCTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />SGI-5 �in�j1j9S/ - S�vJ wa �ve 9�ZD( 3 A1E5 YS l _ <br />CLASS OF WORK <br />Cl NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSIOVE/FRPLANSERT ❑ BUILDING RELFCATION <br />VALUATION OF�WLORKICOSi OF MAIERIA LUS LABOR, <br />Ay A O� <br />DESCRIBE WORK <br />/l/Cw Cons � <br />USE OF BUILDING <br />_ <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <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 <br />-Y-G� <br />LEOALDESC ONOF PROPERTYISH N BELOW OR ATTACH FOUR COPIES, <br />LOT_BLocIL_oF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINE t ICEpf NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - ATHNOLG UNITS - H.P. <br />Z, <br />BATHTUB <br />REFRIGERATION UNITS - H P. EA. <br />LAVATORY I WASH BASIN) <br />BOILERS - B.T.U.IH.P. <br />SHOWER <br />GAS FIRED A.C. UNITS -BTU. 0 a o <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS - B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-8.T.U. M <br />LAUNDRY TRAY <br />I <br />UNIT HEATERS - B.T.U. M <br />�L <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL -- <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />/ <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICF-- BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />i <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTALFEE <br />­NT <br />'LAN CH CK NUMBER <br />W. <br />FEE <br />al-( <br />RECEIPT NO <br />nr�R33_ <br />FAO SE TBW; <br />30A <br />REAR SETBACK <br />2S' <br />SIDE SETBACK <br />z <br />�(gm3 <br />USE' NE <br />5 <br />LOTAREA <br />/3 3_ SF. <br />VACANT SITE <br />(GEs ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF ONSI <br />� — N <br />OCCUPANCY GROUP <br />e.y <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF LIDO 11) 5 <br />'�.f�ol <br />NO OF GIOPIES <br />4aF <br />//Z 9M� <br />MAX. OCC LOAD <br />^' ^ <br />, TF f.J <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES gyNO <br />OTHER <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANSCHECKED BY APPR FOR ISSUANCE BY <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />PROPERTY OWNERS ARE RESPONSIBLE FUH UEI EHMININU ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />