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c APPLICATION FO'iii*�' <br />CITE <br />CITY OFF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />x&ri/9Wtnp6J <br />MAIL ADDRESS CITY ZIP <br />/06/Z -3') D,'? S nleicy 98208 <br />PHONE <br />337-9079 <br />ARCHITECT OR OE SIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS GOY ZIP <br />PHONE <br />LICENSE• <br />:i�Mc <br />A'.S. 0014a- <br />SirtYE& <br />ZIZJ2_ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE LICENSE <br />CLASS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT ❑ DUILDING RELOCATION <br />VALUATION OF COST OF MATEDIA PLUS LABOR) WORKI <br />DCSCRIBE WORK <br />N1 EW (LE' .10MCC <br />USE OF BUILDING <br />.��� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONSOF LAW: AND OPDINANCES GOVERNING THIS TYPE <br />TH WHETHER 3PECIFIEDHERE- <br />�FpRNOORKLTHE GRANTING ILL BE T°APED IERMITDOESNOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STAT' T LOCAL LAWREGULATING CONSTRUCTION <br />OR THE PERFORI.-NICE OF CONSTRUCTION. <br />SIGNATURE OF CO RA TOR OR AUTHOR) 0 AGENT GATE <br />X <br />LEGA.ArDEESSCRI ION OFPROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOr O BLOCKOF&P&�MO #I� 5` <br />PROJECT <br />Ay DRESS <br />4gZco `DoLsew- 6T <br />APPLW.AK S USUIESS CENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET (TOILET) <br />5 <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />J <br />Co <br />REFRIGERATION JNITS-H.P. EA. <br />LAVATORY JWASH BASIN) <br />_� <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />L0 <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />/ <br />DISHWASHER <br />nr <br />CD <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />IUNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />It <br />CLOTHES DRYERS <br />16 <br />URINAL <br />VENTILIMON FAN <br />DRINKING FOUNTAIN <br />RANGE IiLX)D <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />_ <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPLACEINSERT <br />Cm <br />1 <br />SUR TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTALFEE f <br />- <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />�/A <br />REAR SETB ACK <br />as/ <br />SIDE SETBACK <br />/s / <br />PLAN CHEC NUM�Bj.ER //1 <br />l X5�"j <br />LJ 1 <br />PLAN <br />FEES �� -If <br />CHECK FEE �y <br />R_CEIPT NO�c <br />f <br />USEZONE <br />-5 <br />LOTAREA <br />� a �3 <br />V��CE�LNT SITE <br />T ES ONO <br />FEES <br />VALUATION <br />FEE <br />I <br />O <br />TYPE OF CONST <br />OCCUR CYGROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />&CJ /CAISA'r <br />LV <br />l- <br />SIZE OF ^BLDG. <br />NO. OFSTORIESMAIL <br />OCC. LOAD <br />PLUMBING <br />JV <br />(05 <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED Cl YES�NO <br />OTHER A 7 <br />APPLICATION ACC. DY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />PENALTY <br />l Z 22 <br />/` <br />TOTAL <br />,dvy Eit�niAvy aetl ,wc "472,Wac. <br />rsorRjco'vr AC CCO Ta <br />-ry /0/aPwr7vwrtr <br />g4TidGAeridA/ <br />