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S=PPLICATION FO►, <br />the rEEn <br />CITYOF CONSTRUCTION everetl <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASF PRINT <br />❑ DEMOLITION ❑ CQMEIN.ATION 10 BUILDING ❑ MECHANICAL ❑ PLUMBING BSIGN <br />Ti vX" I e- P.SSCc <br />Ir-NaA: 23T <br />Moo FLE 5T' <br />1.tg, 016OI <br />do L[ecj-o0022� <br />AN CHITECT OM 095ION99 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />BE ER' CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP R a O S <br />PHONE <br />LICENSE E <br />tT q.1 I -A V�JEm <TLnI <br />Lip. II-1 C. :512�1 <br />r-�-LIHIGn- PJf..-AIO- <br />SL^-. WA . <br />`�-4-LI LyS <br />ME.(6.I?A81, <br />MECHANICAL OONT ACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />.LICENSE <br />CLAB WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABORI <br />DESCRIBE WORK <br />I f1 ST AL L. I SIN Ln I-rc Fr-E-11- /Zc]EDF r-L 00.-1 T'E66 <br />USE OF BUILDING <br />�rcTAY T Lkr <br />1 HEREBY CERTIFY TI4AT 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 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 />SIGNA E OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X }�,�� I I- I <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT -BLOCK --OF <br />PROJECT ADDRESS (C L�It 0 ` I' f.lni <br />I LIOa JJ L J W y <br />APPLICANTS CITY BUSINESS LCENSE NO. <br />331`1 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS -HP. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINKS 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 />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS- RAINLEADERS <br />METAL FIREPLACE S CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTAL FEE S <br />THIS PORTION TO <br />BE COMPLETED <br />BY BUILDING <br />DEPT. <br />PERSONNEL <br />FRONT SETBACK I <br />REAR SETBACK <br />I SIDE SETBACK <br />I PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE <br />RECEIPT NO. <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />M <br />OCCUPANCYGROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />S <br />NO. OF STORIES <br />MAX, OCC. LOAD <br />PLUMBING <br />IKLERS REQUIRED D YES D NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />ACC,BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUA <br />rr <br />TOTAL <br />;A . Al? __51r40 7U & <br />� <br />il�loAB� c'e_w <br />