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PPLICATION FW <br />evereH <br />TM EF°'"" <br />O <br />CITY Of CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />r___— LL,, Y. Lv (z ,,,{ 953za1 <br />PHONE LICENSEA <br />GENERAL LONiRAQbR <br />MAIL ApORC58 GIN ZIP <br />CLASS OF WORK ,,_, <br />❑ NEW ❑ ADDITION W/ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />.,.. .........,e .anoe llnal nF MATERIALS PLUS LAOCNI <br />WORK <br />Kcwoocc 1�A�, <br />JSEOFBUILDING-, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />BELOW OR ATTACH FOUR COPIES) <br />.ED DESCRIPTION FPROPERTY(SHOWN <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />.oT_BLOCK__OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />GIVE <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. „ <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />` Q <br />APPLICANTS <br />CITY BUSINESS LICENSE NO. <br />•RJEAD <br />RESS <br />IqDf <br />�LUMBINO <br />FEE <br />ANICAL <br />TYPE OF EOUIPRIENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />KLAVATOTY <br />REFRIGERATION UNITS—H.P. EA. <br />_ <br />B <br />FNO. <br />EA. <br />GAS <br />(WASH BASIN) <br />GAS FIRED UNITS —TONNAGE EA <br />FIRED A.C.. <br />SHOWER <br />SHOWER <br />FORCED AIR SYSTEMS—B.T.U. MEA. <br />SINKd DISP. <br />KITWALL <br />HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />LAUNDRYTRAV <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />_ <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— C.F.M. <br />FLOOR DRAIN <br />-- <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE d CHIMNEY <br />_ <br />ROOF DRAINS—RAINLEADERS <br />W ODSTOV /FIREPLACE I SEPT <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT d <br />PERMIT 5 <br />TOTALFEE d <br />TOTAL FEE 3 <br />THIS <br />IONT SETBACK <br />PORTION TO BE <br />REAR SETBACK <br />COMPLETED <br />SIDE SETBACK <br />BY BUILDING DEPT. PERSONNEL <br />PLANCHECKNUMDER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />;E ZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />PEOFCONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />ZE OF BLDG. <br />NO OF STOR'PG <br />MA%.00C. LOAD <br />PLUMBING <br />RE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />PLICANON ACC. BY <br />�` In\\ <br />PLANSCHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />I <br />