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A .PPLICATION LO`. I evereN <br />TAT EY"°'"° <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTME14T <br />259-8745 TO BC COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING 8'SIGN <br />OWNER MAIL ADDRESS Cl/TY- ZIP PHONE <br />/ <br />AR 44, II�LGTr- DESIGNER i'F�/J') L) )A.�s/C4 yZ�..�c- y IN�tD�yU <br />Su/T- 1 <br />GEN/[R'AL CONifl lOR <br />MAIL ADDRESS <br />�" <br />/�Pn� �/�IiV�ll� <br />�;�% �e�rl��ic�9Ro3y <br />��R3i1, <br />TIT LCI I ANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZI <br />PHONE <br />LICENSE <br />Pt UMBIFUT CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />-- <br />PHONE <br />LICENSE <br />CLAS OF WORK <br />WNEW <br />❑ <br />❑ <br />BUILDING RELOCATION <br />❑ ADDITION <br />❑ ALTERATION Cl <br />REPAIR DEMOLITION <br />.1 <br />WOODSTOVE/FRPL.INSERT <br />VALUATION OF WORN ICOST OF MATERIALS PLUS LABORI <br />DescmuL onrc <br />USE OF OUR DING / <br />SP <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />(ITCY� <br />PLICATION AND KNOWTH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNI NG THIS TYPE <br />LEGAL DESCRIPTION OF PROPEBT Y ISIIDWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WH ETHER SPECIFIED HERE- <br />LOT— BLOCK —_OF <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 />PROJECT ADDRESS <br />APPLICANTS CITY SINESS LICENSE NO. <br />1203 S t iEiler A <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET )TOILET <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY I WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINKS DISP. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—R.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUTA BREAKERS <br />STOVE <br />HOOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE—BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTALFEE S <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />USE ZONE LOTAREA VACANT SITE FEES VALUATION FEE I <br />OYES ONO <br />BUILDING S <br />SIZE OF BLDG NO OF STORIES MAX. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />APPLICATION ACC BY PLANSOHEOKEO BY I APPR FOR ISSUANN EgjY <br />['�o TOTAL <br />5 POLO ► AF_-Cls r-:i OF <br />JI <br />