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PPLICATION FO,_.� <br />C <br />ITY OF EY./PMR CONSTRUCTION <br />CITY <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN SNK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDINu ❑ MECHANICAL O PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS TNT ZIP PNIDNE <br />Alice Bateman 5714 Lombard E%-grett 98203 353-8935 <br />ARCHITECT OR DESIGIIER MAIL ADDRESS CITY 2IP PunuF <br />GENERAL CONTRACTOR MAR ADDRESS CHY ZIP PHONE UCUJSEA <br />Everett Builders, Inc. 5606 Evergreen Way Everett 98203 353-7161 EVEREW601PH <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />PLUMBINGCONTRACtOR MAIL ADDRESS CITY ZIP PIUJNE LICENSE• <br />❑ NEW ❑ ADDITION ALTERATION S REPAIR ❑ DEMOLITION ❑ WOOOSYOVE/FRPL.INSFF'T ❑ BUILDING RELOCATION <br />VALUATION OF WORKICOSL OF MAtEF 1p <br />IIALS PLUS LABOR) <br />1,792.00 <br />OFSCRIeE WORK-- <br />Rr..rnnf axichinG hnimn (rrvDF, 90 ,,,1..oci <br />USE OF BUILDING <br />-- -- -- <br />I HEREPT' 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 />OP WORK WILL 8 E COMPLETED WITH WFI ETHER SPECIFIED FIERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAIN REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X*N��Y�'I<< <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOURCOPIES) <br />LOT-- BLOCK —OF <br />PROJECT ADPRESS <br />5714 Lombard Everett, Wa 98203 <br />APPLICANTS CITY BUSINESS LICENSE NO. <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-II.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA. <br />_ <br />KITCHEN SINK d DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY THAY <br />UNIT IIEATERS-B.T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAD E ITS <br />FAETAL FIREPLACE B CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT $ <br />PERMIT t <br />_ <br />TOTALFEE f <br />TOTAL FEF 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />NEAR SETBACK I SIDE SETBACK I PLAN CNFCK NUMBER <br />USE ZONE )LOT AREA (VACANT SITE <br />OYES ONO FEES <br />III <br />T/PE OFCONST InrcuoeurV nnnlm u.. ..e n.,o .a�i...... <br />SIZE OF pIDG NO OF STORIES MAX OCC. LOAD BUILDING <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO -- <br />OTHER <br />PENALTY <br />APPLICA11ONACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br />TOTAL <br />5 <br />FEE RECEIPT NO <br />VALUATION FEE <br />r�r=': <br />