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APPLICATION FOh:) <br />E IT, °.Ron <br />CTY of CONSTRUCTION <br />CIT <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8310 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DE'VIOLITION Of'COMBINATION ❑ BUILDING ❑ MECHANICAL <br />O PLUMBING : ' ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />' �1✓/ /�E c� <br />�� i �esic//E 5%E C f�* <br /><C/so tir/ is <br />S'2 <br />5�Y ? S3 8coo <br />ARCHIIECT CA OESIONE9 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />A __ n __na... <br />:jV,, » <7: <br />I <br />L/ <br />Si SotF <br />Coa 4G 2-19R-2 <br />CITY <br />CI.ASS OF WORF[�,� <br />El NEW Cl ADDITION AT'ALTERATION Cl REP/IR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF M A I ERIALS PLUS LABOR) <br />`'— <br />/r��.i�.�T �.•-+yP_e �.t tiiG�l Fvis ov,40J3 ?? <br />asE,o/f BuaorNc _ v <br />/�'S�$%PLICATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />AND KNOW THESAM1IE TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />WHETHER SPECIFIED HEE­ <br />NFORORKWILL NOT. THE GRANTING O A PIERMIT TH DOES NOTPRESUMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATEOR LOCAL LAW REG U LATI NGGONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRAC 711 OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERFYISIIOWN BELOWORAITACII FOUR COPIES) <br />LOT_eLDCK—oF ...�����2 F_r./EA4F/ <br />K G Oe <br />PROJECT ADDRESS <br />PLUMBING <br />APPL J S CI BUSINESS L CENSE 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/HNDLG UNITS — M.P. <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.0 /H P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B,T.LL M FA, <br />DISHWASHER <br />WALL HEATERS —BT.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF LRAINS—RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC.I <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />IT <br />PERMIT <br />TOTALFEE <br />f <br />TOTALFEE <br />PLAN CHECK NUMBER <br />L7 I�7� <br />FEE �3 <br />�� <br />RECEIPT NO. <br />W/11 be/zoidCUT, <br />FROTTi SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING 15 <br />Q <br />TYPE OF CONS) <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF SLOG. <br />TNO OF STC11ES <br />MAX. OCC. LOAD <br />MECHANICAL <br />— <br />OTHER NOVA <br />0- <br />_ — — <br />FIRE SPRINKLERS PcOUIPED OYES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BV <br />vM/\' r <br />PLANS:HECKED BY <br />APPR. FOR ISSUANCE BY <br />L <br />PUBLIC WORKS <br />TOTAL <br />- <br />—13 <br />PROPERTY OWNERS ARE RE5PONSIBLE FUH Ut I LHP. ANINU ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />