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A `PLICATIO R theCITY E°FFOrFIR CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />9UILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />259.8810 <br />BUILDING El MECHANICAL <br />❑ DEMOLITION [I COMBINATION R <br />-_ CITY LIP <br />MAIL <br />i <br />evereR <br />1 <br />❑ PLUMBING O SIGN <br />PHONE <br />PHONE I <br />BHCNE LICENSE• i <br />CENSE <br />ADRESS CITY ZIP PIIONE LI <br />D <br />HIUMBINO CCNTRACTOR '' <br />CLASS OF WORM. <br />❑ NEW -W ADDITION ❑ ALTERATION El REPAIR ❑ DEMOLITION ❑ W'G:105TUVE/FR PL.INSE RT ❑ BUILDING RELOCATION. <br />LABOR' <br />AT <br />LOI21F BLOCK.-- <br />1 -- — t i.: <br />1 HEREBY CERTIFY THAT I HAVE READ AND EY.AMINED THIS AP• <br />PLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND 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 PFOVISIONS OF <br />ANY OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE I <br />X USINE B9 LICE/j t' <br />A PPLI( CITY BN$E NO <br />70%7 (Ut✓o� d <br />; <br />MECHANICAL , <br />PLUMBING <br />TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. I, <br />q!C — AIHNDLG UNITS — H.P. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS —HP. EA. <br />BATHTUB <br />BOILERS — B.T.U./H. P. <br />LAVATORY(WASN BASIN' <br />GAS FIRED A.C. UNITS —B.T.U. <br />SHOWER <br />FORCED AIR SYSTEMS—BT.U. MEA. <br />KITCHEN SINK 6 OISP <br />WALL HEATERS — B.T.U. M <br />DISHWASHER <br />UNIT HEAT ERS—B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOL ERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN' <br />RANGE HOOD <br />FLOOR OR AIN <br />WATER HEATER <br />BACKFLOW HHEVENTERS <br />WOOD STOVE , <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE A CHIMNEY - <br />SINK (SERVICE — BAR, ETC I <br />FIREPLACE INSERT <br />HEAT PUMP , <br />GAS PIPING ( <br />III 1 <br />EXHAUST <br />9UB TOTAL ' <br />SUB TOTAL <br />IT <br />PERMIT <br />PERMIT <br />IT <br />TOTAL FEE <br />TOTAL FEE <br />ITRECEIPT <br />FEE NO. i, ,� �• <br />PLAN CHECK NUMBER <br />L nUNT SETpAGK REAR SETBACK <br />SIDE SETBACK <br />{ <br />VALUATION FEE "'-- <br />FEES <br />USE ZONE LOT AREA <br />VACANT SITE <br />Dres nao <br />BUILDING <br />"PE OF CONST OCCUPANCY GROUP <br />No OF DWELLING UNITS <br />PLUMBING <br />SIZE OF DlDG NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />I <br />OTHER <br />FIRE SPRINKLERS REQUIRED ONES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY PU 145 CHECKED BY <br />APPR FOR ISSUANCE By <br />I I <br />PUBLICWORKS <br />TOTAL <br />'t <br />e <br />tJ- a <br />ARE RESPOSIBLE FOR DETERMINING ALL <br />PROPERTY OWNERS <br />AND RELATED EASEMENTS. <br />PROPERTY LINE LOCATIONS j <br />;II' ' <br />