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P L I C A T I O N F OMe Eve/preen La's �:��I, . <br />un of <br />CONSTRUCTION ce, <br />everett PERMIT <br />BUILDING DEPARTMENT <br />P59-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />n .. Y. - '� n. - 'c _ _� wA _... Q - _. _ 1. N_ <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL <br />MAIL ADDRESS <br />PHONE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PI(ONE <br />` <br />LICENSE - <br />R�pIVXA N MEt1a�L <br />111 �5�' Awl N <br />. Zliknll, WA glz,C 364-3600 <br />SNoAkMi c)OF <br />CLASS OF WORK <br />Cl NEW Cl ADDITION <br />❑ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ <br />BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />Dv(�CRIBE WORK T- \ I <br />1'L.v.^'J�) tip... R,e �v !? m Al '6 -VIA,S _Q - -Fop G u / G'r , <br />Us F BUILDING <br />I' <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHE SAME TO EL 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 OFA PERMITDOES NOTPRESUME TO <br />rIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE O ONSTRUCTION. <br />SIGNATURE CON RACTOR OR U HORIZ AGENT DATE <br />�Ty) <br />X <br />LE A DESCRIPTION OFPROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOI_BLOCK— OF <br />PROJECT ADDRESS <br />if o-.i ' <br />PLUMBING <br />S9nLt <br />APPLICANTS CITY BUSINESS LICENSE NO <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/HNOLG UNITS — H.P. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS — H.P. FA. <br />LAVATORY WASH BASIN) <br />BOILERS—B.T.U./H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK &CRISP <br />FORCED AIR SYSTEMS —6.T.U. MEA. <br />DISHWASHER <br />WALL HEATERS —B.T.'.J. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHESWASHER <br />j EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESDRYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOUR DRAIN - --_— --- <br />---- <br />OV <br />RANGE HOOD <br />BACI;PR <br />WATER <br />O <br />--RAIN E <br />POl)r DRAINS -- RAINLEADERS <br />ROUT DRAINS <br />STOVE <br />WOOD STOVE <br />SINKISERVICE — BAR. ETC.) <br />p- <br />y <br />METAL FIREPLACE& CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />Z <br />C <br />SUBTOTAL <br />s(p, <br />v <br />PERMIT <br />S <br />PERMIT <br />p p <br />TOTALFEE <br />Y <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />`P <br />FHONi SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA. <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONSL <br />' <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDO <br />NO. OF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES Cl NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAl I- N ACC 137-7 <br />APPLICAII: NACC BY <br />PLANSCNECY.ED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />— <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALI. <br />PROPERTY LINE LOCATIONS AND RELATED EAS_-MENTS. <br />