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?PLICATION FOk'-; <br />the CITYOF »R <br />CITY <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL <br />O PLUMBING <br />SIGN <br />OWNER �n"- <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />�/7ti1 IVtP�/tt�Q <br />�l 1E. �cwrMriz��vY'D <br />;)-�-7330 <br />ARCHITECTORDF.SIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILAODRESS CITY ZIP <br />FIIONE <br />LICENSE <br />O/AAT. Arc.. /.IP <br />f)'l Dn. Air" /'/.A. b.-....n J. III e3o.al <br />Ob%, Oi.......,—._ <br />MECHANICAL CONTRACTOR MAIL AUUHtl. LNY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVC/FRPL.INSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK <br />/At'CrA71 l)/r_ DureAl /(.�V runAz�erZ a/JAt�.uMF'17 <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF 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 />SIGNAT R OF CONTRACTOR OR NOR12 ED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />_ <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOR ERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEAEERS—B.T.U. M <br />LAUNDRYTRAY <br />_ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACES CHIMNEY_ <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT f <br />_ <br />TOTAL FEE $ <br />TOTALFEE f <br />FRONT SE' <br />USEZONE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEFT. PERSONNEL <br />VACANT SITE <br />OYES ONO <br />UFANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />OF STORIES <br />MAY. OCC LOAD <br />PLUMBING <br />O YES ONO <br />MECHANICAL <br />OTHER <br />PENALTY <br />NSCHECKED BY <br />APPH. FOR ISSUANCE By <br />A� <br />TOTAL <br />FEE RECEIPT NO <br />FEES VALUATION FEE <br />S <br />