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Inn EYupr"n <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />CONS RUC HOIN <br />TO'3E CO,:'PLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />; COM5iNATION <br />❑ BUILDING O MECHANICAL <br />O PLUMPING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />(iML/Al •T--i% /n <br />rr'' �ryy pp <br />ITT /1� /Voari/r,+F.<,=Wi>•y�'��r,�-n /yit <br />gy(03%eI COa4-c�sSa <br />AL�)1LA tTS <br />ARCHITECT On DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />uctnsE• <br />* ?4A - <br />- �e�a.00.r.s.- <br />• u�/U . Mr-n17 0.. <br />i93/a5 <br />(2o61 1%3 .- ;? <br />MECHANICAL CONTRACTOR <br />MNLAODRESS <br />CITY <br />21P <br />PHONE <br />LICENSE• <br />TGCaI0/n/0 <br />1Fa �� <br />PLUMBING CONTRACTOR <br />MAIL AODRF,G <br />CITY <br />ZIP <br />PHONE <br />LICENSE� <br />4-.7- Toe <br />v= CiT *. ,Ar <br />L .ASS OF WORK <br />G <br />E�' ❑ <br />REPAIR ❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT <br />❑ <br />BUILDING RELOCATION- <br />❑ NEW ADDITION ALTERATION <br />VALUAIION OF WORK (COST OF MATERIALS PLUS LABOR) <br />_ OC <br />DE,CPIBE ORK <br />. <br />n <br />r•rn--4. <br />USE OF BUILDING J <br />I HEREBY CERTIFY THATI HAVE READ AND EXAMINED THIS AP- <br />ji--7-f}�'�, / �%}K!y y <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIO S OF LAWS TN D O RD I NANCES GOVE RN I N G TH IS TYPE <br />LEGAL OESCnIPIION OF PPOPERTY I,NOWN BELOW OR ATTACH FOUfl COPIESI <br />OFWOi ILL BE CO PLETEDWITHWHETHERSPECIFIEDHERE- <br />MA <br />LOT_BLOGK--OF <br />IN OR OT. THEG N ING PERMIT DOES NOT PRESUME TO <br />GIVE TH ITY T 10 ATE OR CANCEL THE PROVISIONS OF <br />ANYO HE 'TA E L CAL LAW REGULATING CONSTRUCTION <br />OR TH P F A OF CONSTRUCTION. <br />SIGNATU E FC R CT OR AUTHORIZED AGENT DATE <br />L >F_il )/Ci YYY �� <br />v LL <br />X cd e <br />G'rNt/l } LL <br />PROJECIADDRESS <br />APPLICANTSCITY USIN ,LICENSE NO. <br />L 0:;' �. r - 1/ZL , a� <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOIL" <br />COND. UNITS-H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />REFRIGERATION <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EX <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS �. <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />_ <br />VACUUM DSCAKr RS <br />_ <br />___ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE- BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT 5 <br />PERMIT S <br />TOTAL FEE 5 <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />N•p _ <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />I l ,4 <br />r ! <br />OYES gNO <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO, OF DWEILIN <br />51"KI l{L1L.' ,. <br />G---- <br />O <br />S17 <br />OF BLDG. <br />NO. OF STORIES <br />MAX OCC. LOAD <br />t�.�o <br />« AOcA <br />1 <br />IL Lo <br />PLANSCHECKED Bl <br />41 b}I <br />JMBER PLAN CHECK YEE <br />I(�Y5a FEE //F 3 RECEIPTNO. I <br />FEES I'lALUATION FEE <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />6-0 <br />