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the EvuplNR <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />.- PPLICATION FOw� <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />i <br />i <br />❑ DEMOLITION U COMBINATION O BUILDING "MECHANICAL O PLUMBING Cl SIGN <br />OWNER �. <br />MAIL AOORESS CITY ZIP PHONE <br />�UEV� /YIrILI. tjAy EUL-rcTi I,"9Li.�cY� <br />AIICHI I ECT OR DESIGNER <br />MAR AOORESS CITY ZIP PIIONL <br />MAIL <br />ELLASS OF WORK <br />IC�y <br />�.NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORN (COST OF MATCRIRLS PLUS LABORI <br />2:?90 6o <br />BE SCRIBE WORK r <br />., uf.� r, <br />LT... J <br />L L /T / 1 r <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAME TOBETRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />BELOW OR ATTACH FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN <br />WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />OF WORK <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT— BLOCK .--OF <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 />_ <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />IG1 <br />APPLI NTS OF Y BUSWE SLICENS�.� <br />PROJECiF� � , <br />s <br />' L ` v <br />MIt)14 <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />OF FIXTURE <br />AIR <br />UNITSUNIT EA.REFRIGERATION <br />WATER CLOSET (TOILET) <br />RIGERCOND. <br />UNITS—H.P. EABATHTUBLAVATORY <br />BOILERS—H.P. EA. <br />ffFEETYPE <br />(WASH BASIN) <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWERKITCHEN <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />SINKA DISK <br />HEATERS—B.T.U. MLAUNDRY <br />DISHWASHERWALL <br />UNIT HEATERS—B.T.U. M <br />TRAY <br />EVAPORATIVE COOLERS <br />-- <br />CLOTHES WASHER <br />CL--' ES DRYERS _ <br />WATER HEATER <br />VENTILATION FAN <br />- <br />_ <br />URINAL <br />— <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />- <br />_ <br />FLOOR DRAIN <br />STOVE <br />- <br />VACUUM BREAKERS <br />METAL FIREPLACE A CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />R_ <br />WOODSTOVE/FIREPLACE INSERT <br />SINK (SERVICE -BAR. ETC.) _ <br />SUBTOTAL s <br />I PG-- <br />SUBTOTAL <br />PEflMIT 5 <br />.S.OQ__ <br />PERMIT S <br />TOT, <br />c/o — <br />TOTALFEE_ S <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING <br />DEI I. <br />rtHZ)UN <br />NCL. <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />MTONi SETBACK HEAR SETBACK SIDE SETBACK <br />FEE <br />OCCEIPT NO <br />USE ZONE LOTAREA VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />DYES ONO <br />TYPE OF CONST OCCUPANCY GROUP NO. OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF SLOG NO OF STORIES TANK OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />APPUCAIIONACC BY PLANS CHECKED ByAPPR. FOR ISSUANCE BY <br />TOTAL <br />^ ^ <br />