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'`�PLICATION FOf'�:- <br />CITY a <br />the ITYOF rNn CONSTRUCTION <br />OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745. TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />OWNER - MAILADDRESS /`I /1 CITY , . ZIP <br />❑ PLUMBING <br />everett <br />e <br />11 <br />ARCHITECT OR DESIGNER <br />MAIL AUUHt55 , <br />CIT( <br />ZIP <br />PHONE <br />GENERALCONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />(;C—r� R y /I/En <br />(Z c�'�x 5 69 <br />(. YNNvjoo n <br />W, 9POZ9 <br />?76-F 35 <br />f"i5f2yA/,r , - c <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />V NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAIION <br />VA ATION OF WORK OO T OF MATELSPLUSRIALABOR) CC <br />Li� <br />MIC <br />DESCRIBEWORK IpiERIBR 14LUMIIJ/I'J��i IN)CRID/c jLCU/•r/AIRTL'.1'� <br />Tnl<ra , /)) Dl;� Pvl d!J AIL1.t.U7- 5//..AI d- (I) ;v7- JA/m UI nu A-1 J /Ci 1-Cn AA I n, ni <br />USE OF BUILDING <br />DEFZ I- _N j7Q2 <br />M10PLICATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. - <br />SIGNATU E FCONTRA�CTOR OUTIN RIZEO AGENT �7 L? 7DATTE <br />X �aI,\ I/fj, R V11 / 9 J <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK 0 <br />PROJECT ADDRESS • J I <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 A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. MEAL <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />I_ <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />I AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 3 <br />PERMIT S <br />PERMIT f <br />TOTAL FEE $ <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT N0. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />PEES <br />VALUATION <br />FEE <br />TYPE OF CCNST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />OF STORIES <br />APPLICATION ACC. BY <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />G TOTAL <br />11, 5 <br />