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:A <br />APPLICATION FOR- <br />CIrYOF°"° CONSTRUCTION We <br />cln of <br />Everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />0 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ McCHANICAL !Q PLUMBING ❑ SIGN <br />OWNER p�I� MAIL ADDRESS CITY 211' PHONE <br />T'6-.DP / dewe Ap%V s6 4ev1rt en 4e-w8 <br />ARCHITECT OR DESIGNE". MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />211, <br />P110Nr LICENSE <br />UAJi rwV dwes7m eoAV. Po <br />A3ox 33q-28 61r-7NKE 44 <br />gV33 <br />367.IF41 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHHONL LICENSE• <br />PLUMBING CONTRACTOR <br />d0v MAIL ADDRESS CITY p��p�� <br />20 Q1Ai s oAI iDc.��asi1JV 607 sE cwe�ejT M.kc <br />LI'� <br />9 <br />LICENSE <br />PoICHEWu �71 <br />„K 1�� <br />P-O 6 <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION )< ALTERATION ❑ <br />REPAIR ❑ DEMOLIT,UN ❑ WOODSTOVE/FRPL.INSERT <br />❑ BUiLDING RELOCATION <br />VALUATION OF WORK COST OF MATERIALS PLUS LABOR, <br />45-00 <br />' <br />DESCRIBE WORK <br />,Vj-j) fps/AJ6- <br />USE OF BUILDING <br />R-L <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 />PROVISI ONS OF LAWS A N D O RD I NANC ES GOVE RNWG TH IS TY'E <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF PERMIT COES 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 />SIGNATURE or CONTRACTOR On AUTHORIZED AGENT DATE / <br />- <br />X "I�PYI� --V \Y -7(/ZZ/ 9p <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT —BLOCK --OF <br />PROJECT ADDRESS ^, �) <br />3os' SHE G,�GF/ MAL6Ly <br />C6u�r-,� <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLIMAdING <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 AMNOLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY I WASH BASIN) <br />BOILERS — B.T U ,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 —B,T.U. M <br />LAUNDRY TRAY <br />I UNIT HEATERS — El U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC) <br />Q <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUS TOTAL <br />f <br />404, <br />SUB TOTAL <br />PERMIT <br />f <br />/0 <br />OO <br />PERMIT <br />TOTAL FEE <br />f <br />/ S <br />00 <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITL <br />OYES ONO <br />FEES <br />VALUATION <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED ❑ YES D NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATONACC BY <br />PLANSCHECKED BY <br />APPR f0015SUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RE5PUN51 BLE rUH UE I tHMININU ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />