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CccQQ 7 M Sea c-r <br />APPLICATION FO:' r <br />lLLC everetl <br />�� <br />the ,OF/IR <br />Ctry OF <br />lTv O <br />CONSTRUCTION <br />tin C� <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAILADDRESS CITY ZIP <br />PHONE ..r��%� ; O[ <br />Sy/aRs s1�4Fc•+D02 /3AJ2, j�c !2//vZ J-Y 5r--,4 Gic CuA 4dloy <br />APCHRECi OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PRONE <br />S ©^ -/T/� <br />6,u LvD OIL <br />GENERAL ONIRp TOR <br />MAIL A�DDRE�SS�]-/./}�' CITY ZIP <br />LICENSE <br />r <br />� I �C I <br />MAIL' CITY 21P <br />,�-PHHOONEEE <br />PHONE /e�LI�CENS� <br />C TRACTO�Q <br />.� <br />A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE <br />❑ NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOI-IFRPL INSERT ❑ BUILDING RELOCATION <br />VALJATION OF WORK ICOSt OF MATERIALS PLUS LABOR) <br />_1 0DO OO <br />OESCRIBEA�ORK <br />/J< No L./] e7_/""tOyc- TFJ ro oV <br />USE OF BUILDING <br />/�00/7 �S/�2(//L/= <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION.ANDKNOWTHESAMETOBETRUEANDCORRECT.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 />/to. <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOURCOPIESI <br />LOT— BLOCK- OF <br />PROJECT ADDRESS <br />LI R TS CITY BUSINESS LICEN. NO <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 />_-- <br />BATHTUB <br />REFRIGERATION UNITS —H P. EA. <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.0 /H H. <br />SHOWER <br />GAS FIRED A.C. UNITS — B. F.U. <br />/ <br />KITCHEN SINK A DISP, <br />FORCED AIR SYSTEMS — B.T U. M EA. <br />DISH'NASHEP <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. <br />CLOTHES WASHER / <br />EVAPORATIVE COOLERS 4_ <br />URINAL <br />CLOTHES DRYERS <br />DRINKING F <br />Fi <br />VENTILATION F <br />FLO •AI <br />RANG H <br />C <br />SA FL PREVENTERS <br />WATE YhTER <br />DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK(SERVICE—BAR ) <br />METAL FIREPLACE .RMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL <br />S <br />SUB TOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />S <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO, <br />FRONT SE TRACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES A10 <br />FEES <br />VALG.:FION <br />FEE <br />BUILDING <br />sgi o�,P <br />2 91 <br />Qj <br />TYPE OF CONSi <br />_z=r — ^/ <br />OCCUPANCY GROUP <br />B'Z <br />NO OF DWELLING UNITS <br />-t9_ <br />PLUMUING <br />SIZE OF yBL`DG <br />NO OF STORIES <br />MAX OCC LOAD <br />T <br />MECHAIIICAL <br />— <br />FIRE SPRINKLERS REO'11RED RYES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />— <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED SY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY LI <br />WNERS PROPERTY LINE LOCATIONS AND ( BLEFOR IING ALL <br />RELATED EASEMENTS. <br />