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�0011 '``PPLICATION FOk <br />CITY OoF ' <br />CITECONSTRUCTION <br />f <br />everett PERMIT E+ <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING C2' ECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNERn MAIL ADDRESS CITY ZIP PHONE <br />//E,•t..ils I2�/t^/G<'/ SE C�/G'Y'tC7T /%4LL�9>/ r�-✓L'�t.�r <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENER'Ay <br />; <br />MAIy,nJ DRESS/N <br />CC�t <br />CITY 11P <br />PHONE LICENSE• <br />LAC � <br />`Q�,i �- C, <br />�O, Ay- gs EvPlc9 <br />?6Z66 <br />_ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />OQ NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/F R PL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK(COSI OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />USE OF SU 0ING <br />//At�Ty� <br />/C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMITDOES 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 />SIGNAIURL OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X z-zs�a'e <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCti OF <br />PROJECT ADDRESS <br />z/ sE&ZC7r fy� way <br />APPLICANTS CIIY BUSINESS LICENSE 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/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY ( WASH BASINI <br />BOILERS — B.T.0 /H. P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISP NASHER <br />WALL HEATERS—R.T.U. M <br />LA',NDRY TRAY <br />UNIT HEATERS — B.TA: 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 />BA -OW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK ISERVICE —BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />_ <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />_ <br />SUBTOTAL <br />S <br />SUBTOTAL f <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTALFEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIOE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FL. S <br />VALUATION <br />FEE — <br />BUILDING <br />PLUMBING <br />$ <br />TYPEOFCONST <br />Occ7NCYGROUP <br />I <br />NO. OF DWELLING UNITS <br />SIZE OF BLDG <br />I NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />r <br />_/ly <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />_— <br />APPLICA.IONACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />