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0 <br />the EYFFVFM,I APPLICATION FOR P,.PFcll <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER •/] r// / MAIL ADDRESS (rtY 7IP Pllnuc <br />CLASi OF WORK <br />❑ NEW ❑ ADDITION i--ALTERATION EPAIR ❑ DEMOL MON ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATONIOFLVORI. (COST OF MATERIALS PLUS LABOR) r <br />��c� OtJ U <br />ueseHlBE WVHK �� <br />usE or ec:wNc <br />'�' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLACATION AND KNOW THE SAME TO BE TRUEA;VD CORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WI I ETH EF' SPECIFIED HERE- <br />IN OR NOT. THE GRANTING CF A PERMIT DOC,i IVOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANC-L THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULA: f,NG CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. - <br />SIGNATURE OF CON) CTOR OR AUTHOHIZED AGENT DATE <br />LEGAL DESCRIPT ION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR OPIES) <br />uir_aeLocK/ <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO <br />r TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET(TOILET) <br />6 <br />AIR COND. UNITS—H. P. EA <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BASIN) <br />/ <br />BOILERS—H. P. EA <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNORYtRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />z <br />Cam- <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />1 <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />. <br />SINA SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUBTOTAL <br />SUBTOTAL s <br />PERMIT f <br />PERMIT f <br />TOTAL FEE IT <br />) <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL V <br />FRONT ` TBALY. � <br />10 A <br />ecAR SETBACK <br />��Q'F <br />SIDE SETBACK <br />/ - <br />PLRN CHECK INMpEH <br />1 c/ <br />r 7 <br />VLAN <br />FEE <br />AJ <br />LNt FEE <br />RECEIPT NO <br />s98 <br />USE ZONE <br />TOT AREA <br />6(SCl <br />VACANT SRE <br />OYES ANO <br />FEES <br />VALUATION <br />FEE <br />TYPE OiST. <br />/'Vr <br />M:CUPAN YGROUP <br />L <br />NO. OF DWELLING UNITS <br />BUILDING <br />,('�y �... <br />f /TC 'L` <br />C <br />SIZE OF B G <br />Z` <br />NO, OF STORIES <br />MAX OOC. LOAD <br />PLUMBING <br />6 <br />cin <br />FIRE SPRINKLERS REQUIRED ❑ YES Vik NO <br />MECHANICAL <br />!3 <br />L <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANSOHECKEDBY <br />4f_- <br />A PPR FOR ISSUANCE BY <br />Vl- <br />L y/ <br />TOTAL <br />C( <br /><� <br />H <br />n <br />m <br />