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APPLICATION FOR` <br />CITEOF OF CITY <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING P4 MECHANICAL <br />L7 PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADORERS CITY ZIP <br />`ya P�..,..,Pl.sla zt. <br />PHONE <br />ARCHITECT OR OESIONER <br />MA, ADDRESS CITY ZIP <br />PHONE <br />GENFRAL CONTRACTOR <br />Um-,4e t <br />MAIL ADDRESS CITY ZIP <br />fa-1 E MIMI 5e,A, W.. 941.i:3 <br />HONE <br />74.7-3ray <br />LICENSE <br />MECHANICAL CONTRACTOR <br />S1.I'rF� <br />MAIL aODHESS CITY ZIP <br />f-0 6.,1 ass? Ere lE/, <br />PHONE <br />�5N—/y3y <br />LICENSE <br />EuERESMK/ <br />r,v"f <br />RI UMAINRroNTRACTOR <br />MAIL ADDRESS LIL! Z V <br />PHONE <br />LICESE <br />11— yr -- <br />CA NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/F RPL.I NSE RT ❑ BUILDING RELOCATION — <br />VALUATION QF WORK ICOST Oi MALERMLS PLUS LABORI <br />i/l 500..R <br />DESCRIBE WORK <br />J .n I \II _ — -,-I— _ <br />USE OF STRONG <br />fiLVI / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION At ID KNOWTHE 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 AUTHORIZED AGENT DATE <br />X l��_ s.c e. �e-JS-- <br />LEGAL OESCAIPTION OF PROPERTYISHOWN BELOW OR AITAQH FOUR COPICSI <br />LOT_BLOCK --OF <br />Gree. 4v-ew- SE-zg <br />PROJECT ADDRESS <br />3as S.E. i!Eet d M.L6 <br />APPLICANTS CITY 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 ITOILETI <br />A/C — A/HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T U /H P <br />SHOWER <br />07 <br />GAS FIRED A. C. UNITS —BT.U. 71—IC. <br />KITCHEN SINK d DISP. <br />FORCED AIR SYSTEMS — B T.0 M EA. <br />DISHWASHER <br />WALL HEATERS —B.T U. M <br />LAUNDRY TRAYM <br />UNIT HEATERS — B.T.0 M <br />CLOTHES WASHEREVAPORATIVE <br />COOLERS <br />URINALCLOTHES <br />DRYERS <br />DRINKING FOUNTAINVENTILATION <br />FAN <br />FLOOR DRAINRANGE <br />HOOD <br />BACKFLOW PREVENTERSWATER <br />HEATER <br />ROOF DRAINS — RAINLEWOOD <br />STOVE <br />_ <br />SINK (SERVICE — BAR. ETMETAL <br />FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />MEAT PUMP <br />GAS PIPING <br />2 <br />EXHAUST FAN <br />SU <br />SUBTOTAL <br />PEPERMIT <br />TO <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />— <br />BUILDING <br />5 <br />TYPE OF CONST <br />OCCUPANCY GROL <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />(_J <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ yE5 ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APRA FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />C Y <br />o...IOIeI c cno ncrROLIINTNG AT 1 <br />I ROPER) T Vpn�O. CATIONS <br />PROPERTY LINE LO:.ATIONS AND RELATED EASEMENTS. <br />