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APPLICATION FOP. evereR <br />TAT Evuprsen <br />CITY of l <br />CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING O SIGN <br />OWNER MAIL ADOPLSS CIIV ZIP PWiNE <br />.v��r i,�lcs� �D �®�, %_ /�ilie.�,rys 07GsZ �cJ zw - *Ad <br />AR CN ITECTOR DESIGNER MAIL AD VESS CHv Z P,IONE <br />GENERAL CONTRACTOR MAIL ADURESS CITY ZIP PHONE } • LICENSE <br />MAIL <br />CITY <br />ZIP <br />LICENSE <br />CLASS OF WORK <br />❑ NEW 'X ADDITION ❑ ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR, <br />/DS 9c36: °D -- <br />DESCRIBE iFORK 1 71- <br />use of Buaowc �/� <br />T���f <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORREOT.ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNI NG TH IS 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 />ANYOTHER STATE OR LOCAL LAW REGULATINGCONSTRUG ION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />IT <br />LEGAL DESCRIPTION OFP OPEnTY SHOWN BELOV/ OR A n ACR 1 OUR COPNfa <br />LOT— BLOCK -_—OF <br />'— <br />PROJECT ADDPESS <br />APP NTSCI�dNLSS LICENSE NO <br />PLUMBING <br />JeeiANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSCT (TOILET) <br />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — M.P. EA. <br />LAVATORY (W ASH BASINI <br />BOILERS — B. T.0 /H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — BT.U. <br />KITCHEN SINK 1 DISP. <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS —BT. U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />_ <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />_ <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL f <br />SUB TOTAL <br />3 <br />PERMIT ItPERMIT <br />3 <br />TOTAL FEE f <br />TOTAL FFE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIOE SETBACK <br />USEZONE <br />LOT AREA <br />VACANT SITL <br />OYES ONO <br />FEES <br />BUILDING <br />VALUATION <br />$ <br />TYPE OF CONSi <br />OCCUPANCY GROUP <br />NO.OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY LINE LOCATIONS AND RELATLO EASEMENTS. <br />