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APPLICATION FOk <br />TE CIOF <br />CITY CONSTRUCTION <br />CI <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />rn nFMOLITION M/clo '1BI NATION ID BUILDING ❑ MECHANICAL <br />mtt-I lt <br />9H <br />> y tH/Z <br />0 x0 <br />lit H "i1 <br />(n F. <br />H3 r <br />m0 <br />H t7 <br />0 Hg <br />�• CnCgg <br />9 H3 <br />rHH <br />!n <br />gd� <br />H O 14 <br />C <br />eveFeR <br />e <br />❑ PLUMBING ❑ SIGN <br />GEA4LCO R5IfR <br />MAIL ACORES$ <br />c <br />CITY <br />Sov <br />LIP <br />PHONE <br />Na�tN06- <br />LICBbE• <br />��bD�s <br />1y Wo�, <br />o� b12lG>�7 <br />- <br />�c�o��e�5 <br />MECHANICAL CONTRA TOR <br />IAAIL ADDRESS <br />LT <br />L <br />P O E <br />ICE E <br />PWMBING CUNiRLL10R <br />MAIL sODRE55 <br />UiV <br />ZIP <br />PHONE <br />LICf 4if <br />CLASSOF WOPK <br />❑ <br />REPAIR CTJ <br />DEMOLITION <br />❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION <br />ALTERATION <br />..............��...i,n-.•'ncf /�f Yll(RIA,S PLUS Lf H(iRI <br />_ <br />..3..._... s <br />7 _ EOF BUILDING <br />Y = C ILL-''1 <br />I HEREBY 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 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 ','HE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REG ULATI NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. /16 <br />CON TRACTOR OR AHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTYISNOWN BELOW OR ATTACH FOUPCOPIESI <br />�p �q <br />LOI lk0LOCK/Za O(. EJ.Qfe ess S T (• <br />.-.r ed20� YJlolq Ci 156 2>!'tP tills ZO <br />�J I <br />IcIII `\-Lt��eSIGNATURE <br />1ta�o� �id L^ <br />PROJECT ADDRESS <br />',�?SZZ_ <br />kkL Lle(fP�/ <br />AFFIICANTS Y DUSINESS L cLNSE NO <br />PLUMBING <br />MECHANICAL <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 - A/HNOLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P EA. <br />LAVATORY ( WASH BASINI <br />BOILERS- BTU/HP <br />SHOWER <br />GAS FIRED ABC. UNITS - S T.U. <br />KITCHEN SINK 6 DISP <br />,`� <br />FORCED AIR SYSTEMS - B.T U. M EA. <br />DISHWASHER <br />WALL HEATERS -B.T U. M <br />LAUNDRY TRAY <br />UNIT HERS ERS - B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />`j <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTALFEE f <br />TOTAL FEE <br />Lu4l SETBAh <br />{+LAN L:HECK N MBEP <br />S` � l QPcz <br />FEE <br />P' <br />105 <br />RECEIPT NO <br />0 _ <br />REAR SEIBACA <br />SIDE�SIT04CK <br />;, <br />u`.d:UNE <br />- <br />LOTAREA <br />AtA <br />VACANT SITE <br />❑YESXO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />SJS /I� <br />C' <br />"I'l (Y CONST <br />-� <br />OCCUPANCY ROUP <br />�.'j �/ <br />NO OF OWFLLLILNG� UNITS <br />PLUMBING <br />FILL OF BI DG SF <br />Sob3 <br />NO OF STORIES <br />Z <br />MAX OGG LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES 60 <br />STATE BUILDING SURCHARGE <br />.cvl K�LpN a::c B• PV.NB L'H ECFED BY <br />Y Y ` <br />APPR FOR ISSUANCI: BY <br />I�J <br />-' <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />n ...� evPenuclnl <br />P cno nFTFRMINING <br />ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />