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t,L?PLICATION LOG. <br />L.et"t <br />The CITY OF EverPING <br />CONSTRUCTION <br />everett <br />PERMIT <br />�) <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />��yy <br />❑ COMBINATION EK13UILDING ❑ MECHANICAL ❑ <br />PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY 2:P <br />PHONE <br />�� <br />liuiST- ddle iLEi�� `' 015-r <br />62_-%HIf? <br />E ' F�iuS <br />.Sri✓i7zE- <br />.? <br />ARCIRTECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />Z"= <br />PHONE <br />Sc /- <br />'ya <br />a-3 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE <br />MECHANICAL CUUMACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONF LICENSE• <br />IIDIIG <br />/1CcVl� <br />_ <br />PLUN_DINO CONTMCTOR <br />MAIL ADDRESS CITY ZIP <br />PION[ lKENSE• <br />9 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION O ORK ICOST OF MATERII LS LUS LADORI <br />ISM <br />•+c tl <br />USE OF BUILDING <br />/_/t' <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 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 AUTHORIZEL AGENT DATE <br />X4 / / <br />2n <br />APPLICANTS CITY BUSIN SS Y'P <br />MECHANICAL <br />_ NO. TYPE OF EQUIPMENT FEE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWOPATTACH FOURCOPIESI <br />LOT_BLOCK OF - <br />PROJECt ADDRESS <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />_ <br />REFRIGER4TION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />-, <br />DIS14WASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS _ <br />- <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 />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE & CHIMNEY <br />SINK SERVICE -BAR, ETC <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUBTOTAL <br />SUBTOTAL S <br />_ <br />PERMIT 5 <br />PERMIT S <br />TOTALFEE G <br />TOTAL FEE & <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SIDE SETBACK <br />USE USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES PITD <br />TYPEOFCONST. <br />OCCUP-NGY GROUP <br />NO, OF DWE UNO UNITS <br />SIZE C•BLDC <br />NO CF STORIES <br />MAIL OCr, LOAD <br />218`x• 34' <br />'LICATION ACC. BY PLANS CHECIIEOU <br />Z= <br />FORISSUANCE <br />L•4 <br />"// <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />l O I FEE <br />FEES VALUATION FEE <br />5 Z. 33 <br />000 glaze <br />