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,.PPLICATION 1`01_ <br />eve.en <br />CITE""°'"° <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />�41-UMBING ❑ SIGN <br />OWNER <br />M� 7.7 <br />MALL ADDRESS Cltt LP <br />mAt-L Mo 5E.F-�l"i F M4ct L A <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRE55 CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />PHONE LICENSE• <br />MAIL ADDRESS CITY ZIP <br />MECHANICAL CONTRACTOR <br />MAIL ApORE55 CITY ZIP <br />Box aU�7 SAFA1 245 MoV <br />PIIONE LICENSE <br />9GJ-331I mcr. 3 w <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE <br />❑ NEW Cl ADDITION AALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />UATIONOFWO .ICOSTOF MA -R IALS PLUS LABORI <br />L <br />O L/T`J^-i-Ll r^J\ ^I�1 / 'ten ',, / <br />DEscR� - WORK I�f4 -S�tt) 1 �LVU( C- �� VW 5 ?- / /-'„ j 6- 4 <br />USE OF RIIILDING <br />f m 6 <br />I HEREBY CERTIFY THAT 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 T H IS 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 1HE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON CTOR OR AUTHORIZED AGENT DATE <br />x % 6O. I -3/_g`1 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOURLOPIFs; <br />LOT— BLOCK —_OF <br />PROJECT ADDRESS <br />ISl Ste. F-v"--77 1114LL <br />W11 <br />APPLI .A TS CITY BUSINESS LICLNSE NO <br />F67?1-&j <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITCILET) <br />A/C — AIHNOLG UNITS — H. P. <br />BATHTUB <br />REFRIGERATION UNITS — M.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T U./H P <br />SHOWER <br />GAS FIRED AD. UNITS — B.T.U. <br />_ <br />KITCHEN SINK f 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 />COOLERS <br />URINAL <br />THES DRYERS <br />DRINKING FOUNTAIN <br />TILATION FAN <br />FLOOR GRAIN <br />GEHOOD <br />BACKFLOW PREVENTERS <br />ER HEATER <br />ROOF DRAINS — RAINLEADERE <br />OD STOVE <br />SINK (SERVICE — BAR, ETC) <br />BEPORATIVE <br />AL FIREPLACE fl CHIMNEY <br />PLACE INSERT <br />T PUMP <br />PIPING <br />AUSTFAN <br />SUBTOTAL <br />f <br />/S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />� <br />TOTALFEE <br />(R <br />(RUNT SET04CK <br />—_ <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />5 <br />TYPE OF CONST <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 />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPl IC47IONACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />clol C Cn0 FICT=mAIMINr AT I <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />