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&PPLICATION SRO -'' <br />T EYsrpr«n <br />CITY OF <br />CI <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETEn IN INK- PLEASE PRINT <br />0 DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />GENERAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSE <br />�-t �/.��1 0 -;r i.�/i�_..7r�.t. �cr ,4�./l-�.l�.t�J✓ 13G>J t_ A.c� ��� S I �� Ga <br />IA ECHANICALCONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONIRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />Cl NEW ❑ ADDITION <br />IALUATION OF WORK,COST OF M. <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.I INSE FIT ❑ BUILDING RELOCATION <br />USE OF BUILDING - <br />0�Fr7—,-Q <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOf_BLOCK --OF <br />PPO.ECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIYFURE OR ITEM <br />WATER CLOSET (TOILET) <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />A/C — A/HNOLG UNITS — H P. <br />FEE <br />L ATHTUB <br />REFRIGERATION UNITS — N.P. EA. <br />N <br />LAVATORY ( WASH BASINI <br />BOILERS -- B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — 8.T.U. <br />KITCHEN SINK A DISP, <br />FORCED AIR SYSTEMS —B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. NI <br />CLOTHES WASHER <br />EVAPORA TIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VEND'.' ATION FPN <br />FLOOR DRAIN <br />RANGE HOOD <br />_ <br />SACKFLOW PREVENTER;i <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE —BAR. ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />"EAT PUMP <br />GAS PIPING <br />E;.HAUST FAN <br />SUBTOTAL <br />$ <br />SUBTOTAL. <br />PERMIT <br />% <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />PLAN CHE K NUMBER <br />S�gI <br />FEE <br />K- <br />RECEIPT NO. <br />q-7830 <br />FRONT SETBACK <br />NEAR SETBACK <br />- <br />SIDE SETBACK <br />USE ZONEn <br />(.: —/ <br />LOTAREA <br />VACANT SITE <br />OYESItO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />��� <br />Sp <br />TYPE OF CCNSi. (OCCUPANCY <br />' �— A/ <br />GROUP <br />a - ,� <br />NOO°G\YELLING UNITS <br />e — <br />PLUMBING <br />SIZE OF BLDG <br />I <br />NO OF STORIES <br />MAk. OCC. LOAD <br />J <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED AYES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />FUSLIC WORKS <br />go <br />APPLICATION ACC BY <br />fA\ <br />^, <br />PLANSCHECKEDBY <br />APPR. FOR ISSUANCE <br />BY <br />TOTAL <br />- <br />PHUHtH 1 Y UWNtHE AHc rvn ..I ALL. <br />PROPERTY LINE LCCATIONS AND RELATED EASEMENTS. <br />