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rePPLICATION FOK ki <br />cl"OF "° CONSTRUCTION <br />I ln of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />0 DEF'OLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUMBING ❑SIGN <br />MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DEWGN•R : <br />MAIL ADDRESS I <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />C" <br />ZIP <br />PHONE <br />LICENSE A <br />MEC14ANICAL CONTRACTOR <br />MAIL, ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL .... L➢> —I 1 —.c uwuc - <br />�Ztic li l�S is °an 111 3wmil, �a 36` 3-ao 16 f <br />LLA55 OF WOnK <br />❑ NEW Cl ADDITIONL_� ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT C BUILDING RELOCATION <br />VALUATIONOF WORK (COST OF MATERIALS PLUS I ABORT <br />V'Tlu.rh A,link A_AQYTL. FLI.(PAl "SnAL_. 1-1- <br />US E OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. 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 />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOI_BLOCK_OF <br />PROJECT ADDRE" S <br />1402. J@,T_v Ie't. AIL"''U W S L l� <br />APPLICANTS CITY BUSINESS UCEN.. <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 (TOILET) <br />A/C—A/HNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H P. F.A. <br />LAVATORY (WASH BASIN) <br />BOILERS — R.T.0 1H P. <br />SHOWER <br />GAS FIRED AC. UNITS — R.T.U. <br />KITCHEN SINK A DISP. <br />S'. <br />b Cf <br />FORCED AIR SYSTEMS - B T U. M EA. <br />DISHWASHER <br />WALL HEATERS-R.T.U. M <br />LAUNDRY TRAY <br />I <br />UNIT HEATERS -BT. U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />O <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK. (SERVICE - BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />S <br />SUBTOTAL <br />O <br />PERMIT <br />S <br />PERMIT <br />I) <br />00 <br />TOTALFEE <br />5 <br />j . <br />TOTALFEE <br />I1. <br />b <br />PLAN CHECK NUMBER <br />FEE I <br />RECEIPT NO. 2 6 /� <br />E PONT SETBACK <br />REAR SETBACK <br />SIOE SETBACK <br />USE ZONE <br />Lot AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <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 O NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />ADTELL CAtIONACC BY <br />\,A <br />FLA14SCHECKEDBY <br />AFTER FOR ISSUANCE BY <br />PUBLIC WOFlKS <br />TOTAL <br />50 <br />PROPERTY LINE LOCATIONS AND RELATED EASEMEN7S. <br />