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..PPLICATION FOs1 fYFTFN <br />CITE "° <br />CITY OF CONSTRUCTION 0 <br />OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />M1 (7f4EA MAIL ADDRESS OIry ZIP PHONE j 3 %- [) {' F• <br />.(//�i.///J/�/i Jf� Llii'c'�/L.'C'%'%/-i S'CId.I 5. CMG/i�fli/�c/ _/</) _LH� 1%clriL/S `I,I' 1 t <br />GENERAL CONTRACTOR <br />MMLADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE- <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />❑ NEW ❑ ADDITION '0 ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEFIT ❑ BUILDING RELOCATION <br />VAL AIIOI:OF WORKICOST Of MATERIALS PLUS LABOR( <br />DESCRIBE WORK �✓JU /ilr.t .7..0 'T ..'n /�'Inuc b-J J/'F Ay[iF<i rf= /•iG✓/ln_! Yif p.?, <br />!` 11 1"11W /17 loll/ /Zc FA/•Z/I I:F <br />7 <br />ti <br />USE OF BUILDING <br />SJ:'/•'/'l (rf /lr y/> r� <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 LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WH ETH ER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF 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 />il) el <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWOR ATTACH FOURCOPIESI <br />..Cr7. jLr �.. 7 Dry/Si �r� <br />LOF'J LLOc OF !c'tR E' <br />PRO.ECT ADDRESS <br />APPLICANT'S 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—H.P. EA <br />LAVATORYIWASH BASIN) <br />BOILERS—H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK A DISP. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN _ <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />_ <br />ROOF DRAINS—RAINLEADERS <br />_ <br />_ <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT <br />TOTAL FEE II <br />TOTAL FEE _ S <br />THIS PORTION TO BE COMPLETED BY BUILDING. DEPT. PERSONNEL <br />FRONT SETBACK <br />USEZONE ILOTAOEA VACANT <br />ES OSITE NO 1 FEES VALUATION FEE <br />D <br />BUILDING <br />S <br />LS <br />U(� <br />OF BLDG <br />NO. OF STORIES <br />MAK OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />SPRINKLERS REQUIRED D YES ❑ NO <br />OTHER <br />PENALTY <br />s V J <br />'CATION ACC BY PLANS CHECKED BY APPR. FOR ISSUANCE BY <br />/ <br />G �C, <br />TOTAL <br />