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,,PPLICATION FO..' <br />evereN <br />The Erefpmen <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />pWg <br />FngW,t4og 4 Wgee_. <br />MAIL ADDRESS CITY ZIP <br />a? 25 32G' PvS.+J.E. � SEAliL61 <br />PHONE <br />Wa. 1116115, <br />�;z7- 2oa5 <br />ARCHITECT On OESIGNCR <br />�{G-SOS 1'(ULVa+tM(,P <br />MAIL AOORCSS CTY ZIP PHONE <br />Z41TITS 1220o fiId1TI�UP WN( Q,CtL6✓U�, W��B� (-76a <br />CITY ZIP <br />PHONI. <br />LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITYZIP <br />PHONE <br />UCENSEr <br />PLUMBING CONTRACTOR <br />MAIL ADDRE$. <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />CUSS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAL TION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />I rhp, o e90 <br />DESCRIBE WORK <br />n. l �- d7l I..r Qp-rally hFk �L411.t�i <br />USE OF eun.DINO <br />SG-2ULAE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />r/vr(oNfo$I�E <br />PLICATION AND KNOWTHE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL OESCnIPTPTN OF PROPEITTYISHOWN BELOW OR AITACHfOUR COPIES) <br />OF WORK WILL BECOMPLETED 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 />see Sy <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OP CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />•ES$LICENSE <br />PROJECT ADORES$ <br />APPLICANT'S CITY BU NO <br />rvr rT MAU— f MCI- MAY <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE FEE <br />NO. <br />TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR CONE. 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 SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA - <br />DISHWASHER <br />— <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />0 <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 FIREPLACE 6 CHIMNEY <br />SINK (SERVICE —BAR. ETC) <br />WOODSTOVE)FIREPLACE INSERT <br />SUB TOTAL $ <br />SUB TOTAL <br />l <br />PERMIT S <br />PERMIT S <br />00 <br />TOTAL FEE $ <br />--------------- <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />LPLAN <br />REAR SETBACK <br />3,4 <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />CHECK FEE <br />FEE /JRECEIPTHO 79(n� <br />/ <br />USE ZONE <br />LOT AREA <br />•f� • <br />V CAM SITE <br />AYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />-rl <br />OCCUPANCYyyROUP <br />f I- 4—I <br />NO, OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG NO. OF STORIES MAX OCC. LOAD <br />-I'LoD S1" I�{�d. <br />FIRE SPRINKLERS REQUIRED O YES $ NO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />)M • VVl <br />PLANS CHECKED BY <br />.�F,F <br />APPR. FOR ISSUANCE BY <br />�' <br />TOTAL <br />LC roll E e�Yti �Ir Mp y <br />1 `0 ► Jv.o Plzc� lrzE3�Sv� <br />.. IF <br />