Laserfiche WebLink
r� ;4PPLICATION FO+A% 5 <br />On `OF CONSTRUCTION �J3g� <br />everett PERMIT E+ <br />BUILDING DEPARTMENT <br />259-8745 rO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMbLIYION 1' ❑ COMBINATION 91,13UILDING ❑ MECHANICAL 06 PLUMBING ❑ SIGN <br />OWNER .. MAIL ADDRESS CITY ZIP_ PHONE <br />6KG Gfau tSN BPflu l 9UL3 2"d D2SE eY�L ��2�8 3Y 3-m9 o <br />ARCHITECT ORDESIGNER��-•, MAIL ADDRESS CIIV ZIP PHONE <br />T�9&JEY ' 2AK9:SSWAW 5-28 F� Rc& ET�yCl8Zo7o <br />GENERAL CONTRACTOR MAIL AdtI ( ZSZ- 643L <br />PHONE LICENSE <br />G &at G 4V2_3 Z"d o(- SE f%6xtel- !?221 399-3QLo <br />MECHANICAL ONTPACTOR ; L MAIL ADDRESS CITY ZIP PHONE LICENSE <br />I <br />nvr•einu wmn.�, u,. .,�i. �,.,.��oo ..�„ ur rnun! LICENSE <br />IM NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRP(.INSERT ❑ BUILDING RELOCATION <br />Meeumee wunn <br />S/Ac/CTLC �n1/LY �/D�ii/t('� -NEW �/J5�-YIuC'7pnJ <br />USE OF BUILDING <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 Or <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 s ! 7167 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT--LBLOCK --OF <br />_T►{`-E_r`ji,�[''I--`?-j <br />PROJECTADDRESS <br />II 492o <br />_ <br />APPLICANTS CITY SINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />' NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />/ <br />AIR COND. UNITS-H. P. EA. <br />• ' <br />BATHTUB <br />/ <br />U <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />/ <br />BOILERS-H.P. EA. <br />SHOWER <br />/ <br />GAS FIRED A.G. UNITS -TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />IF <br />DISHWASHER <br />WAIL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />bo <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />S_ <br />URINAL V L <br />VENTILATION FAN <br />OO <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN' - -` <br />AIR HANDLING UNIT- C.F.M. <br />• <br />VACUUM BREAKERS <br />-/- <br />STOVE <br />" <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLAC A CHIMNEY <br />SINK SERVICE -BAR ETC. <br />/ <br />WOODSTOVE/FIREPLACE INSERT <br />w <l <br />- <br />V,... <br />'•` SUBTOTAL <br />SUBTOTAL S <br />lio <br />"- <br />-`PERMIT E <br />PERMIT f <br />- <br />TOTALFEE 9 <br />Q <br />U <br />TOTAL FEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />�(:)L15 FEE ICJlk RECEIPT NO <br />USEZONE LOTAREA .( ANi SITE `i <br />X� FEES I VALUATION I FEE , <br />I <br />SIZE OF Si <br />n <br />ONO <br />OCCUPANCY GROUP NO. OF DW LLING UNITS <br />A/ R_3 <br />5 <br />N, # , <br />APPLICATION ACC. BY <br />PLANSCHECKED BY <br />APPR. <br />FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />