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, .PPLICATION FO <br />CITE""°`"" <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL <br />L <br />ZIP <br />❑ PLUMBING <br />V <br />❑ SIGN <br />GENERAL CONTRACTOR MAILADDRESS OILY ZIP PHONE LICENSE• <br />❑ NEW Cl ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRPL.INSERT El BUILDING RELOCATION <br />VALUATION OF WORM (COST OF MATERIALS PLUS LABOR( <br />DEsc.lyl-IN�NN . /1 Rn�nt/ �tk O/a `" K. <br />t _� <br />Y�r L✓1 �w�-' <br />-�— -- <br />INPre"C!.r-{ <br />OC 5E <br />YG1"�j <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />I <br />-�3" 'OC�t <br />f" <br />7 <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />_TT <br />LLOALDESCRIPTIONOF PROPERTY IBIIUWN OELOW OR ATtA HFOUR-OPIE51 <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BLOCK --OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES 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 />SSII�GGNN�AATURE OF CONTRACTOR On AUTHORIZED AGENT DATE <br />?S <br />APPLI CITY BUSINESS LICENSE NO u <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <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 - AIH14DLG UNITS - H.P. <br />REFRIGERATION UNITS - H.P. 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 />FORCED AIR SYSTEMS - B.T.U. M EA. <br />-_ <br />KITCHEN SINK 6 DISP. <br />WALL HEATERS- B.T.U. M <br />DISHWASHER <br />UNIT HEATERS -B.T.IJ. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />RANGE HOOD <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />WATER HEATER -._`� di• <br />ROOF DRAINS - RAMLEADERS <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />SINK (SERVICE - BAR. ETC.) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />3 <br />SUBTOTAL <br />_ <br />PERMIT <br />PERMIT <br />TOTAL FEE <br />Sr <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />IR5NT SETBACn <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />5 <br />DYES nN0 <br />BUILDING <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWFLLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLN+S CIIECNED B'r <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />EE <br />Fnn OFTFRMINING ALL <br />PROPERTY LINE LOCATIONS <br />..SA _.._._ATE <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />