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APPLICATION FOk, <br />E EilN <br />CITE <br />CITY`OF <br />OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />J <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION � BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OW1 NEB <br />1` MAIL ADDRESS CITY 711, <br />PHONE <br />t4=NNY CPJ� Ie <br />111G. 7700 EL G4w11N0 JzL 65r%, P- w <br />(iA <br />2;z�= <br />APCHITECf OR DESIGNER <br />Kcvir� McCOQMI <br />MAIL ADDRESS City ZIP <br />' 7W EL eAM/NDZAOLbeAp <br />Lg <br />PNONC <br />PN2LV,5 L NCL14lE <br />GENERAL GN �� <br />���All ADURCS �� �� � �y ZIP <br />W05 5Z5 _)LENS_ <br />MECHANILALCONf RCTOD <br />MAIL ADDRESS city ZIP <br />/ <br />PHONE LICENSE. <br />C—L M�r�aN�c,��-- <br />PLUMBING CONTRACTOR <br />MAIL AOORES5 CITY ZIP <br />PHONE LICENSE• <br />NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIIION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />TION OF WORN ICOST OF MATERIALS PLUS IJ.BORI <br />TE w^NT <br />USE OF BUILDING <br />Wtfk�5 <br />H-r LC� ��sr <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 />PROVISIONSOF LAWSAND ORDINANCES GOVERNI NG 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF ONTRACIOR on T14ORIZED AGENT DATE 7-I0-ef5 <br />I <br />LEGAL DESCRIPTION OF PPOPERTYISHOWN BELOWOR ANACN FOURCOPILST <br />LOT- BLOCK -oF <br />PROJECT ADDRESS <br />;i505 CE <br />lk4 <br />APPLICANTS CITY BUSINESS ),ICI NSE 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 />BATHTUB <br />REFRIGERATION UNITS - H P EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS - 8. T.L .H P <br />SHOWER <br />GAS FIRED A C. UNITS -- B.T.U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS -- B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS -8.T U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES 09YERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />RANGE HOOD <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEATFUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMIT <br />SUBTOTAL 3 <br />PERMIT 3 <br />TOTAL FEE <br />f <br />TOTAL FEE <br />)'LAN GM CK NUMBER FEE RECEIPT NO. <br />2S Z44 �� o`� lJ �D� <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />_ <br />USEZONE <br />C- <br />LOT ARTA <br />VACANT SITE <br />OYEs�,D <br />FEES <br />BUILDING <br />VALUATION <br />$ <br />FEE <br />TYPE OF CO 5i <br />' /y <br />OCCUPANCY GROUP <br />- Z <br />NOO^DWELLING UNITS <br />'1:9 <br />PLUMBING <br />SIZE OF BLDG <br />Z/' S4:s <br />BO OF STORIES <br />MAR OCC LOAD <br />�o <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS PEOUIRED ❑ YES NO <br />STATE <br />UILOING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />� <br />YHUYtH I T V WNCHJ MTTC RCJrV IYJIo1.0 T V n Mc I CnmllvnV nL� <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />