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the EI+FSTPSR Lir PPLICATION FO"F, Tbm zu11-pl� <br />CITY OF CONSTRUCTION <br />everett PERMIT eYe,e„ <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />0 DEMOLITION ' O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL <br />h C[ <br />teOS <br />GENERAL CONTRACTOR 'fj, 0 D`SACa. <br />MAIL ADDRESS - <br />I d •T �L CUY ZIP <br />PHONE LICENSE <br />tav%si %&e6b:-, Aye-N. StwiiLc- <br />9$13'5 367380I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />/ et <br />CITY ZIP <br />.Y}4v 6:d <br />PHONE, LICENSE <br />UnitwowA. a}-}Yl:s'-kme.- <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />IA <br />m <br />Lcu�ss of WORK <br />7LJ NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 0WOOUSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION ,KIcuSI OF maul LnlRlnl <br />JII. j In .dG a A� , o0o f� ¢2 90 . oZ)o ¢ 9 "7 �•q . 39 <br />New 15-6e <br />wwbeel-f;- v%, T roLiv 0 V Y\Ir I M" [s b' flc'fTD� <br />USE OF BUILDING <br />RGk_�\ I <br />1' 1', 01 <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 />PROVISIONS OF LAWS AND 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 />SIGNATURE OF CONTRACTOR OR ALI HORIZED AGENT DATE <br />X L <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK—_OF <br />PROJECT ADDRESS <br />APPLICANTS CITY DUSONESS 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/HNDLG UNITS - H P <br />' <br />BATHTUB <br />REFRIGERATION UNITS - HP EA. <br />LAVATORY I WASH BASIN) <br />BOILERS - B.TM /H P. <br />SHOWER <br />GAS FIRED ABC. UNITS - B.T.U. <br />KITCHEN SINK S DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN - <br />RANGE MOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE -BAR, ETC) <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />�'%'1C t�1iw\C •� <br />j <br />HEAT PUMP <br />\ I <br />GAS PIPING <br />1. <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTALFEE f <br />TOTALFEE <br />PLAN CHECK NUMBER <br />s? /�s <br />FEE <br />188/,E3 <br />RECEIPT NO. <br />�a(voej <br />FEE <br />IZ45 IA S <br />FRONT SETBACK <br />0 <br />REAR SET BACK <br />0 <br />SIDE SETBACK <br />0 <br />USEZONE <br />LOT AREA <br />VA NT SITE <br />ES ONO <br />eN <br />FEES <br />VALUATION <br />BUILDING <br />yy.A <br />S7 (J{Af%T <br />TYpL.Q"ONFLST <br />' <br />J+r'v <br />OCCUPANNCYGROUP <br />( <br />l✓ �Z <br />NO. OF DWELLING UNITS <br />151- <br />PLUMBING <br />SIZE OF BLDG <br />/� /' O� Z L <br />`i <br />NO OF STORIES <br />MAX OCC LOAD <br />cog • / �1. / <br />%NK <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED YES ❑ NO <br />STA7E BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAIIONACC BV <br />\^ A <br />,y) <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNEFS AHE HESHUINW ULL YUH UL I [HMININU ALL <br />Q = lif PROPERTY LINE LOCATIUNS AND RELATED EASEMENTS. <br />