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XPFICATION FO.. <br />IAA EY.i°'..R CITY of CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />ri DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL O PLUMBING ❑ SIGN <br />IWNER MAIL ADDRESS CITY ZIP PHONE Cc <br />.AI/ . "I _ Imo..-lN. — " <br />•OCHRECT OR DESIGNER <br />MAIL ADDRESS <br />CIFY <br />ZIP <br />PHONE <br />a S€LF7 <br />;LITERAL COIHAACTOFI <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />C5cLF7 <br />'AFCHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />21P <br />PHONE <br />LICENSE <br />'LUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIWNE <br />LICENSE <br />l4 SOi wOPK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />COO • BSA <br />r0\A 1. I11111 PI I'a /n I:,1131 '1 it.110 <br />IsE DF�RJ'LDINc <br />/�C-S•�DC�yT� t7� <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AN 'I 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 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 PERFORMANUE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED A ENT DATE <br />�7 5 <br />X /cm <br />APPLILANTSCIW-A IFESSEICENS O <br />MECHANICAL <br />EGALDESCRIPTIONOFFROPERTYISHOWN BELOW OR ATTACH FOURCOPIESI <br />01_BLOCK OF <br />5 \ <br />"ROJECi ADDRESS h T,� <br />%��Ale/Mt/Z RZ-) <br />PLUMBING <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 />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />(`.� <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK & DISP. <br />OD <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. <br />_ <br />_ <br />LAUNDRY TRAY <br />_M <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />_T <br />CLOTHES DRYERS <br />_ <br />SD <br />URINAL <br />% <br />VENTILATION FAN <br />(1a <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />f <br />SUB TOTAL S <br />S� <br />_ PERMIT S <br />_ <br />I_ <br />PERMIT f <br />TOTAL FEE s;I <br />s (L <br />U <br />TOTAL FEE $ <br />I q- <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING DEPT. <br />PERSONNEL <br />'FIGHT SETBACK <br />BEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />5d <br />�c I (D`M I <br />11 JV <br />FEE <br />'j f13I{i <br />(�li <br />RECEIPENO <br />7'1�1 <br />/ <br />)SE ZONE <br />- A F <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />F <br />AFF�. <br />5, AC. M1nF <br />DYES ONO <br />T <br />OCOUPANCY GROUP <br />NO OF DWELLIN <br />>J <br />R-3 m, <br />I <br />3.Y3tMl <br />r <br />NO OF STORIES <br />Ik6nSET <br />MAX OCC LOAD <br />— <br />UGARONACG BY I PLANS CHECKED BY I APPR. FOR ISSUANCE BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S <br />0 <br />