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t 'PLICATION FOK e <br />Ns EYmpreen <br />CITY OF <br />CONSTRUCTION <br />61 <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.6810 TO <br />BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER J �% MAIL ADDRESS CITY /2J1P PHONE <br />//_/U /l S.—/I / Rll /��O/' M& ; .,zg �i/XRA.tHt COL_%OSO� /z—,T;y�..�•Z/¢. <br />ARC II ITECTOR D71GNE RIB �/1 MAIL AO7DR <br />SS ClI ' /tZIP PH NE <br />�rk� �/ <br />�tJsffN!_Tt/F_ n A. �e7p3.1 .9 /3- i'3'�- ^O// <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />/,VC ��//Z '%,5-tAl�, <br />J.-�A/ONOM/Sii 19:120 <br />MECHANICAL CONTRACTOR MAIL ADDRESS , CITYZIP PHONE LICENSE+ <br />/—/lF/3 /iFF/✓ S:GTF_ SHXE t- /%4rA/A <br />PL,U�M9/,ING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />('///Or/AVT l Y�os <br />'Lil�yv arT/ss <br />CLASS OF WORK ,--,�� <br />❑ NEW ❑ ADDITION L7 ALTERATION <br />_ <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR; <br />o O <br />DESCRIBE WORK <br />i - <br />usEOF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LEGALDESCRIPTIONOF PROPERTYISHOWN BELOW OR AiiACH FOURCOPIESI <br />r <br />' <br />OFWORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />LOT —BLOCK OF <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATI'' CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />!/ <br />PROJECT ADDRESS <br />APPULANTS' iY BUSINEKSLICENSE NO <br />/_2LB <br />PLUMBING <br />MECHANICAL <br />I <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 — AYHNOLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — N.P. EA. <br />LAVATORY I WASH BASIN) <br />BOILERS—B.T.U./H. P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />'NALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />j <br />j CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />I <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />$I <br />TOTAL FEE <br />17NONT SETBACK <br />REAR SETBACK <br />SIDE SEIDPCK <br />PLAN CHE KNUMBER <br />FEE <br />5 <br />RECEIPT NO. <br />8� I�iS� 3 <br />/ 3v <br />�j <br />FEE <br />USEZONE <br />C_ <br />LOT AREA <br />VACANT yTE <br />OYES <br />FEES <br />VALUATION <br />BUILDING <br />S <br />/ <br />NO <br />a <br />TYPE OF CONS; <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />-Iz <br />-1!9' <br />PLUMBING <br />SIZE OF SLOG <br />�'7o7 S� <br />NO OF STORIES <br />/ <br />MAIL OCC LOAD <br />ARO <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED OYES NO <br />_ <br />S <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAHON ACC BY <br />PLANS CHCCKEO BY <br />APPR. FOR ISSUANCE HY <br />PUBLIC WORKS <br />`,`'•�Y <br />,'l` <br />/6X,� <br />/j'LQ� <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />