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APPLICATION FOR <br />TAT EYarprnn CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITQjI ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />arscKrttCi U R DESIGNER <br />MAIL AUUHLSs <br />Dln <br />ZIP <br />PIIONC <br />—� <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP <br />PRONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />-7 <br />✓/%�o%ltanT /�/�/�PlY�iinl/n <br />./ <br />` SG� .i�mir`!�'35Z <br />SIX 9�7� <br />/Il�ti��p/ b <br />CLASS F WORK <br />❑ NEW ❑ ADDITION <br />1,P/ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT <br />❑ RIIII nINn <br />RFI nrATInM <br />� ' IB WORM. <br />Ail, - h i,o Lk 9- Tinian _ <br />USE BUI LNG, <br />I HEREBY CE-iTIFY "HAT 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 F CONTRACTOR OR AUTHORIZED AGENT DATE <br />AlthICANTS CITY BUSINESS LIC SE NO <br />LEG ILDESCIYnTIONOF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PROJECTAODPESS <br />laq0 21 SE uj <br />PLUMBING <br />Li <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-A/HNOIG UNIT„ H.P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B. T.U./H P. <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />I <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DIAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE - <br />SINK (SERVICE -BAR. FTC.) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />MEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL <br />f <br />SUB TOTAL <br />PERMIT' <br />$1 <br />PERMIT <br />_ <br />TOTALFEE <br />sl <br />TOTALFEE <br />FROrvf SETBACK <br />RFAR SETBACK <br />SIDE SETBACK <br />P LAN CHECK NUMBER <br />1 <br />FEE <br />RECEIPT NO, <br />USEZONE <br />LOT APEA <br />VACANT SITE <br />OYES <br />❑YES ONO <br />FEES <br />VALUATION <br />- <br />FEE <br />BUILDING <br />S <br />—- <br />TYPEOFCONST. <br />_ <br />OCCUPANCY GROUP <br />NO.OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG-- <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL. <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPUCATIONACC BY <br />PLANSCHECKED By <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR OETERM INING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />