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the Enfar"n <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />!._'?PLICATION FOF:` <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING <br />O MECHANICAL <br />❑ PLUMBING <br />'SIGN <br />OWNER <br />MAIL ADpRE55 <br />CITY 21P <br />PHONE <br />7r-m <br />B&a ftpg <br />F L Sas 5E. E/f�r <br />p;h w y Sa, �� .zq <br />riojetT' <br />ARCHIfECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE A <br />A l eG_ _ L .1f' <br />OA 01 .T, h7/_4 /Lli r. F._... A. Q911// <br />—T�r or Qa.... <br />♦Il..�.—. <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />UATION OF Won K LOST OF MATERIALS PLUS LABOR) <br />3s3o <br />DESCRIBE WORK <br />I AFCrA71 /A/7Y�L,htt /t_4wt4u„u,4r'Fb GIA'LL -rnfm Rs=Ad? rinvM T' <br />USE OF BUILDING <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 />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT C-CES 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 />SIGNATUR CONTRACTOR OR AUTHORIZED AGENT DATE <br />X at, 14f, <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW On ATTACH FOUR COPIES) <br />LOT—BLOCK_OF <br />PROJECT ADOPE$S <br />rvTy/ f t'u&?Ctr MftL w 54'/7F.2Y <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />331 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND, UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK E DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE S CHIMNEY <br />SINK SERVICE —BAR, EIC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT f <br />PERMIT B <br />TOTAL FEE $ <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />• <br />REAR SETBACK <br />�� <br />SIDE SETBACK <br />PLAN CHECK N UMBER <br />PUN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />I <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />I NO. OF DWELLING UNITS <br />SIZE <br />OF STORIES MAX. <br />APPLICATION ACO BY I PLANS CHECKED BY APPR FC, TICE BY <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />