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the EvergrMR <br />t ?PLICATION FOk. <br />CITY OF <br />ZONSTRUC <br />everett <br />M TT I O N <br />w <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION t%BUILDING ❑ MECHANICAL <br />O PLUMBING ❑ SIGN <br />OWNER <br />=TT FaAFY�RI-CoLO <br />MAIL APORE55 CI1Y .I! <br />yoo SPC.HDT ( eo 18 All�afaQOL;s ss�4o <br />PRONE <br />C HECIORDESG ER <br />AL DORESS 1 <br />CIIV <br />�Ola -s4o -0 00 <br />ryP <br />SF4Mf- 45 RBous <br />FRONE LICENSE <br />MECHANICAL CONTRACTORoFC,s,roM f3L4f SALA65ss 3S114of cr£ THC !n$��_ s31-7vd/ CLIA)TCdF .20� <br />Cliv ZIP PRONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />19 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK 1 COSr OF MATERIALS PLUS LABOR) — <br />JV/5,8f,0-v8 <br />DESCRIBE WORK <br />T£fJAJT TeAPenr)swAtiar — <br />USE OF BUILDING <br />- or-FI Iti, -- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHE SAMETO BE TRUE AND r(1RRECT. ALL <br />LEGALDESCRIPIIONOFPROPERTYISHOWNBELOWORATTACHFOURCOPIESI <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LOT— BLOCK _OF <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL <br />THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAIURE or CONTRACTOR OR AUTI CHI ',,ENT DATE <br />-- <br />:- <br />�yRGJEcr ADDRESS <br />a <br />APPL )CAN i5 CRY BUSrNE 55 LACE NSE NO — <br />.7 <br />weoS fuEe rr -MALL Wa - Su 1rT. oZo <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) _ <br />FEE <br />A/C - AIHNOLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H P EA. <br />LAVATORY (Wr SH BASIN) <br />BOILERS -B.T.U./M P. <br />SHOWER <br />GAS FIRED A C. UNITS - B.T.U. <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS -B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS -B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR GRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTER$ <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />-WOOD <br />STOVE <br />SINK (SERVICE -BAR, ETCJ <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%MAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTALFEE <br />T RONt SETDACn <br />FEAR SETBACK <br />SIDE SETBACK <br />PCLAANC UM CKK NUMBER <br />FEE <br />RECEIPT NOS./L <br />L1o�C>Ci�I <br />1 <br />I 1 <br />FEE <br />USE ZONE <br />C / <br />01 MEA <br />s0 <br />FEES <br />VALUATION <br />OYES�O <br />YES <br />BUILDING <br />TYPE O�NSI <br />- / <br />OCCUPANCY GROUP <br />5 -Z <br />Slr., <br />NO. OF DWELLING UNITS <br />PLUMBING <br />'ems <br />SIZE Of BI pG ` NO OF STORIES <br />2.27p <br />MAX OCC LOAD <br />J F / <br />Z <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUI RED �S YES O NO <br />� t <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPI ICZTION ACC By PLANS <br />CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />^ <br />TOTAL <br />� <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />