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+OPLICATION FO1 tYEFQ„ <br />the °'"" <br />OF <br />Itt OF <br />CONSTRUCTION <br />CICY <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />_.....__ <br />MAIL ADDRESS CITY TIP PHONE _ _ _ <br />r <br />`Pf >•E• EVE <br />eo--o <br />Lc <br />MME ADDRESS <br />CITY <br />IJp <br />PHONE <br />ARCHRGL OR DESIGNER <br />MAIL a0URE55 <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />GENERAL CONTRACTOFI <br />CITY <br />ZIP <br />P140NE <br />LICENSE <br />MEC�ONTPACTOR <br />MAIL. ADDRESS <br />MAIL ADDRESS <br />CITY <br />bP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSERT ❑ BUILDING RELOCATION_ <br />VALUATION OFWORKIC05TOrAIA1E'— PLUSLAPC;b <br />—. a, A-- A"V-- — <br />DESCRIBE WORK T/• T 7 I / / , 7 /I / /1'.•_ _ I. I/1.•."�'I <br />yer.C' IJ e-�11 I. 3 1Or Z Cl AFJ Tii A</11 ri <br />•—�_ <br />USE OF BUILDING �) �. <br />`f/ TkV/ Y <br />; <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATIONAND KNOWTHESAMETOBETRUE AND CORRECT. ALL <br />o 14 w <br />LOW OH PILCH ouRcoPlEs <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTYISHOWT <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANI"ING OF A PERMIT DOES NOT PRESUME TO <br />LCIT_BLOCK OF <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 CON I RACTOH OR AUTHORIZED AGENT DATE lJ <br />X <br />APPLICANT'S CITY BUSINE SLIC_NSE NO ' <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENTMEX <br />WATER CLOSET JOIN <br />MC — A/HNOLG UNITS — H.P <br />REFRIGERATION UNITS — HP EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS — B. T.0 /H P. <br />GAS FIRED A C. UNITS — B T.U. <br />SHOWER <br />KITCHEN SINK 6 DISP, <br />FORCED AIR SYSTEMS BTU <br />—B.TU. ADISHWASHER WALL HEATER. <br />UNIT HEATERS — .. <br />BTU AtLAUNDRY <br />TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAH. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />SUBTOTAL <br />S <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTAL FEE <br />)'LAN CHECI NUMBER FEE <br />RECEIPT NO. <br />FEE <br />FRCNT SETBACK <br />REAR SETBACK SIDE <br />SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />OYES 13NO <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />- <br />PLUMBING <br />SIZE OF SLOG <br />NO OF STOP <br />MAX.00C LOAD <br />MECHANICAL. <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANT CHECKED BY <br />APPR FOR ISSUANCE By <br />PUBLICWORKS <br />TOTAL <br />— <br />laol v MR nFTPRMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />