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NS EruyTnn APPLICATION 1 OkJ T:YBTCI <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINAl ION ❑ BUILDING Cl MECHANICAL ❑ PLUMBING ❑ SIGN <br />❑ NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORKIDOST OF MATERIALS PLUS LABORI <br />�-,3 0o 11 <br />DESCL�RI�BE WORK <br />I It'IPII`jiv1P, <br />USE F BUILrN <br />/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BETRUE AND CORRECT. ALL <br />PROVISIONSOF 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 />X <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES; <br />LOT_— BLOCK _OF <br />-- <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MFCHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />I <br />FEE <br />140.1 <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILE-) <br />A/C - A/HNDLG UNITS - H.P <br />BATHTUB <br />REFRIGERATION UNITS -11.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-B.T.U./HP <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK A DISP. <br />FORCED MIT 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 />ci, <br />rn <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />G <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER IIEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />o <br />TOTAL FEE <br />PLnN CHECK UMBER <br />FEE <br />RECEIPT NO. <br />TRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE LONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING IINILB <br />PLUMBING <br />as <br />Do <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />Go <br />FIRE SPRINKLERS REOUIRED ❑ YES D NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAT ION ACC BY <br />,,, ^ <br />�MV � <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />p'C/ <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />