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The EYFFpNe, . APPLICATION FO.. P,TTPG{ <br />COY OF . CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />CANER — MAIL ADDRESS CRY _ ZIP PHONE <br />04 I" UUPQIPC� <br />GIQLl <br />MUYi- HVE <br />�'UF�'G'T7—lJ�l, <br />7F201 <br />0,58-2033 <br />ARCHITECT OR DESIGNER <br />MAIL AOUPESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />Zip <br />PHONE <br />LICENDFA <br />�' <br />— A <br />MECHANICAL CONTRACTOq <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENEE• <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PIIONE <br />LICENSE <br />CLASS OF WORK <br />(3 NFW ❑ ADDITION ❑ ALTERATION X REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK COST OF MATEnIA PLUS LABORI <br />L <br />OF1S/SnIBE WORK <br />ILFr/A/'C OrrT'T!�) <br />(' <br />FOANAU IJ_ <br />rI,roTZ'IAY ITi; <br />A <br />IA).G'FV.4 <br />USE OF BUg01 NO <br />r oc 'FchMl �y / n ZJ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINA14CES GOVERNING THISTYPE <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />SI19 <br />r <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOWOq ATTACH FOUR COPR51' <br />LOT— BLOCK OF— <br />PROJECT ADDRESS <br />2 a o l✓.4-75 <br />AP CANTS OI^r'fif SS ENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET(TOILET) <br />I <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN <br />GOILERS-H. P. Eq. <br />_ <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <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 />— <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT 3 <br />_ <br />TOTALFEE S <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />FRONT SETBACK <br />FEAR SETBACK T <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />MAN WIECK FEE <br />FEE RECEIPT NO <br />USEZONE <br />LOTAREA <br />YACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING S <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />I PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />