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A .PPLICATION FOL evercN <br />CIT <br />f ITV OF ECONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT 259 8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING L] MECHANICAL O PLUMBING ❑ SIGN <br />EVIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />OWNER <br />i"II/10 <br />ARCHITECTOR DESIGNER <br />MAIL ADDRESS <br />CITY <br />JIP <br />PHONE <br />' <br />i�•'// <br />AIAII ADDRESS <br />CITY <br />11P <br />PHONE <br />LICENSE • <br />GE NERAL CONTRACTOR <br />Nnn�r' <br />IAAII. ADORE•', <br />--CITY <br />/IP <br />PIIONC <br />LICENSE <br />MECHANILAI. L@ITRA(,TOR <br />MAII ADDII(:d:- - —_ <br />--- CITY <br />ZII` <br />PIIONC <br />IICLHSC <br />PLUMBINGCONIDACION <br />CLASS Of WORK <br />❑ REPAIR <br />❑ DEMOLIIION ❑ <br />WOODSTOVE/FRPL.INSERT <br />❑ BUILDING <br />RELOCATION- <br />Cl NEW Cl ADDITION <br />ALTERATION <br />DESCRIBL WORK' <br />USE of wLowo <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIbIONF',OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />ATTACH FOUR COPIESI <br />LEGAL.SCRIPTIONOFPROPERTYISHOWNBELOLVOR <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LGT_.BLOCK_OF <br />G'VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. yq [� Z�/ <br />SIGNAIURE OI' CONTRACTOR OR ALIIHORIZED AGENT DA E / 11 (f / <br />X <br />111 11I&/ <br />APPIIC.ANTBLI Y BUSINESS LICENSE NO <br />PPOJELT ADDRESS <br />p Fvl-F,Ti <br />" <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF IPMENT <br />EQU <br />FEE <br />NO. <br />AM UNITS - HP . <br />- <br />WATER CLOSET ITOILETI <br />EFRIGERATIONUNITS -IiP EA. <br />REFRIGERATION <br />EF <br />_ <br />BATHTUB <br />BOILERS -BTU/H P. <br />LAVATORY 1 WASH BASIN) <br />_ <br />- <br />GAS FIRED A C. UNITS - B T U. <br />SHOWER <br />- <br />AIR SYSTEMS - 9 T ll M EA <br />KITCHEN SINK A DISP <br />WALLED <br />WALL HEATERS - BTU. M <br />_ <br />DISHWASHER --- <br />_ <br />UNIT HEATERS - Ell .U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />-_ <br />'- <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR GRAIN <br />WATER HEATER <br />13ACKFLOW PREVENTERS <br />WOOD STOVE <br />ROOF DRAINS - RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE - BAR. ETC I <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />_ <br />SUB TOTAL <br />S <br />SUBTOTAL f <br />PERMIT f <br />PERMIT _ <br />3 <br />TOTAL FEE <br />TOTAL FEE f <br />HECLIPT NO <br />- <br />✓t AN CHECK NUMBER <br />FEE I <br />SIDE SETBACK <br />_ <br />I RITNT SE TBACK REAR SETBACK <br />USE ZONE <br />LOT AREA <br />VACAN B L <br />FEES <br />VALUATION <br />FEE <br />8111LDING <br />S <br />_ <br />s o <br />140(10 1U 'INC, UNITS <br />"PC O <br />OLCIIPANCYGROUP <br />PLUMBING <br />_ <br />SIZE OF BI DC. <br />NO OF BID IES <br />2 <br />AMA DLO 1 OAD <br />N� <br />MECHANICAL <br />/oO <br />OTHER <br />FIRE SPRINKLERS EOUIRE� NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR fORISSWNCE BY <br />PUBLICWORKS <br />�c G• <br />TOTAL <br />c Aoc occonNSIRLF FOR DETERMINING ALL <br />PHVrcHI T vl­•....... .. _. <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />