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* tPPLICATION FOWL <br />ths OF°"" clPfCONSTRUCTION <br />ITY Ever <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL Ig PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />dZ vkJ o L 6t6;0 r <br />ARCHITECT OR DE510NER MMI AODRf 55 CITY iIP PHONE <br />LItV ZIP PRONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS city ZIP PHONE LICENSE <br />2L7b(5- S2L_ 41E <br />7?q-Zgk d <br />NEWV ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLIIION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCAIION <br />vnu nx wnRxP051 a, M A I L R iA LS PLUS L A BOB, <br />D([1SCRIBE WORK !!�� <br />T/...JI_.r . J A.4TFr.n. <br />1•^--�ylr r- ,I- - -�f <br />us of BI:RDINc,' Q <br />Oj <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S�ICjG 517 Ems✓ <br />PLICATION AND KNOW THE SAMETOBE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCBIPT ION OF PPOPERI VI SHOWN BELOW OR AT TACIT FOUR COPIE51 <br />OF VIORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE• <br />LOT_BLOCKL OF <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 />SIGNAIU OF CONTRACTOR AUTHORIZED AGENT DATE <br />x 7?1 <br />PROJECT ADDRESS <br />APPL.ANT9C1 USME$ ISE NO <br />30t4SG <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 ITOILET) <br />L <br />•, <br />AIC— A,HNOLG UNITS —H. P. <br />REFRIGERATION UNITS — H P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />J ) <br />BOILERS —B T.UIH.P. <br />GAS FIRED A C. UNITS — B.T.U. <br />SHOWER <br />FORCED AIR SYSTEMS —B.T U. M EA, <br />KITCHEN SINK A DISP <br />ERS—B.T.U. M <br />DISHWASHER <br />RS — BIT .U. M <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />"I <br />VE COOLERS <br />RYERS <br />mm <br />URINAL <br />DRINKING FOUNTAIN <br />N FAN <br />FLOOR GRAIN <br />OD <br />E <br />" '� i <br />BACKFLOW PEIEVENTERS <br />TER <br />�� <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />V <br />METAL FIREPLACE A CHIMNEY <br />IL— <br />_�� <br />FIREPLACE INSERT <br />�YM <br />I.t:CJQ ,1 'K <br />HEAT PUMP <br />- <br />GAS PIPING <br />EXHAUSTFAN <br />SUS TOTAL f <br />--� <br />SUB TOTAL <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />-r- <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />RNB SE IBACK <br />510E SETBACK <br />.RUNT SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />5 <br />DYES ONO <br />BUILDING <br />TYPE OF CON51 <br />OCCUPANCY GROUP <br />NO OF pWRLING UNITS <br />PLUMBING <br />SIZE OF BLOG <br />NO Of STORIES <br />MAX OCC I GAD <br />MECHANICAL <br />' ) <br />7 <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />STATE ENERGY SURCHARGE <br />Aw'I ICAIION AF.0 BY <br />PLJNSCRECKED BY <br />APPR FOR ISSUANCE Br <br />PUBLIC WORKS <br />/ <br />TOTAL <br />I <br />RCTCGAIIMIND Al l <br />PROPERTY PROPERTY LINE <br />O <br />LINE LOCATIONS AND RELATED EASEMENTS. <br />