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In. EYopFMR =PPLICATION FOk _ We <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />252.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL 0 PLUMBING ❑ SIGN <br />DWN + ue1 T�LL� MAIL ADDRESS ZIP PHONE <br />} , (c CITY C 2 <br />RTrGlnnf�.r?acK�nry �l)I�I I Qut.,✓e�'('(�/ W�. `3h?���' ��3-7aS(v3`• <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PNONF <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRAC R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />❑ NEW ❑ ADDITION <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE,FRPLANSERT ❑ BUILDING RELOCATION <br />v. MAI HIALa PWSLABOR) -- <br />�� 4l <br />USE OF BUILDING <br />��� � )g -)\_ <br />' <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 LAWSAND ORDINANCES GOVERNING THISTYPE <br />OFWORKWILLBECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE I,JTHORITY TO VIOLATE OR CANCEL THE i ROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF 'ONSTRUCTION. �- <br />IGNAI CONTRACTOR OR AU ORI AAGENT DATE <br />LEGAL DExmPTlq OF PROPERTY) SHQy NBELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK —OF— <br />�qnA'' <br />{L( o �tlw..-e <br />0 <br />PROJFCT ADD ESS,,kVL!C{\ L(� -LC!'KL <br />30s S t (U1,L1.0 )"YLalO Olr.I,- <br />APPLICANTSCIT DDx SS UL 5 O <br />tT <br />PLUMBING <br />N6N CAL <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 />BATHTUB <br />REFRIGERATION UNITS - M.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS -B.T.U.;M.P. <br />SHOWER <br />GAS FIRED A C. UNITS - B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />I UNIT HEATERS - B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />RANGEHOOD__ <br />WATER HEATER <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS - RA!N' EADERS <br />WOOD STOVE <br />SINK (SERVICE.. - BAR, ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT t <br />PERMIT <br />TOTAL FEE f <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />/`///T , I <br />LUTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE O��/ vNST . / <br />y � /V <br />OCCUPANCY GFpOUP <br />q " ./ <br />NO. Of DWELLING UNITS <br />Z� <br />PLUMBING <br />SIZE OF BLDG <br />-s C <br />% <br />NO OF STORIES <br />I <br />/ <br />MAX. OCC LOAD <br />.l� <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED 0ES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CH ECM BY <br />APPR FOR ISSUANCE BY <br />l <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING. ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />