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the Enrpresa rPPLICATION FO►'. reveret;) <br />CITY OF CONSTRUCTION <br />everett PERMIT l% <br />BUILDING rEPARI'MENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING kY IGN <br />OWOER MAIL ADDRESS CJTY / ZIP PHONE <br />jS /�lcc� Go /zos Ski eU%d y C°'vey ci7`z a - 2t_ � _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PI ONC /,C <br />iENERAL CONTRACTOR <br />MAIL ADDNESS <br />CITY <br />- i]P <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />Pilo <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE • <br />CLASS OF WJRK <br />Tr NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 0 WOODST)VE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUAT ION OF W/RK IGOBi OF R(ATEDIALS PLUS LABOR( <br />rJ� C/ l/ _') V _�- <br />DESCRIBE WORK � / <br />usenCF B,U,IICnINc J ,Q ,[% / <br />/YF'/Gt // �C �� /I P���/�l ��� '/ <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHESAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 OF CONTRACTOR OR AUTHORIZED AGENT DATE /�/ <br />X / <br />/ C� % /d b <br />LE A( DESCRIPTION OFPROPERTY (SHOWN BELOW RATTA..Y I-UVH OPIE51 <br />LOT -BLOCK -OF <br />PROJECT ADDRESS <br />AP LICANTS CI USINESS LICENSE NO. <br />-;�zoi y <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUFE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TO —TT) <br />AIR COND. UNITS—H.P. EA. _ <br />REFRIGERATION UNITS—H.P. EA. <br />_ <br />_BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />_ <br />GAS FIRED AC. UNITS —TONNAGE EA. <br />_ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE —BAR. ETC. <br />WJODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL s <br />PERMIT s <br />PERMIT AS <br />_ <br />_ <br />TOTAL FEE It <br />TOTAL FEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />GEE <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UfIITS <br />BUILDING <br />NO OF STORIES MAA. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />RED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />PLANS CHECKED BY APPR. FOR ISSUAT6 <br />A-t' _TO TOTAL <br />&•/Qoe <br />