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me EY,,,T„D ..PPLICATION FO.. <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBIN)AtT�IOFN($S 1� BUILDING ❑ MECHANICAL <br />OWNER`/ <br />�J I-(LL ri 1"7 DR�J, <br />I (I <br />SIC <br />❑ PLUMBING ❑ SIGN <br />R -�095 <br />PHONE <br />1 5 3n7-3loCb <br />V101 lyJAQ,, 7n LOV)i -A I!/IDI,1-1 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />I <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK T� <br />❑ NEW ElADDITION W ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />YL V`J IMO V XI <br />USE OF eunowc (:7/I 7 <br />'%1�Q Icl.°- ?� �I ��7 CI IIC'I" <br />i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHESAMETO BE TRUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNI'JG THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHET HER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OE <br />ANYOTHER STATE OR LOCAL LAWREGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED GENT DATE <br />/. 7 Il <br />LEGAL DESCRIPTION OF PROPER Y(SH OWN BELOW OR ATTAC I I FOUR COPIES) <br />LOT— BLOCK OF <br />'(� % / / (I(A (`. <br />// <br />L. (�& Ja <br />PROJECT ADDRESS - <br />Ic osA �SE Ere. a4l Elo II H-a j Ev-� <br />APPLICANTS CI YBUSIKE BUSINESS LICE NSENO. <br />PLUMBING <br />i <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 />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA, <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE _ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACES CHIMNEY <br />SINK (SERVICE —BAR, ETC <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 5 <br />_ <br />_ <br />PERMIT S <br />_ PERMIT 5 <br />_ <br />TOTALFEE S <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />/ <br />PLAN CHECK NUMBER <br />J/ <br />��^� I <br />PLAN <br />FEE /rt(_ 3Q <br />CHECK FEE <br />RECEIPTNO. 70(o-- , <br />v�lL JU <br />USE ZONE <br />/ ' ,� / <br />LOTAREA <br />VACAN TE <br />OYES O <br />FEES <br />VALUATION <br />FEE <br />TYPE qftI9NST. <br />.S/_— ICI <br />OCCUPANCYGROUP <br />5 _ 7 <br />NO. OF DWELLING UNITS <br />_C5 <br />BUILDING <br />SIZE OFBLDP.. f �T• <br />I7l��.ST Ty <br />NO OFSTORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REOUIRED ❑ YES 4NO <br />MECHANICAL <br />OTHERPENALTYaPPLICAl10N <br />` <br />TOTAL <br />ILI <br />t4_)c <br />ACC BY <br />PLANS CHECKED BY <br />�M <br />APFOR ISSUANCE OY <br />