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r hPLICATION FOk-/ <br />i . ,,,,EY.FQIIIR <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />i <br />eR <br />❑ SIGN <br />OWNER MAR.AUUntoa I'll ur vnLrvC <br />Cafl l� 12q I Irl� a 1 17_G-YL+TcI; 47 �v-e-re tt �s�o3 33�• 33 ra <br />ARCHITECT OR DES'@TER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS '..TY ZIP PHONE <br />_0 w I ¢ I, <br />MECHANICAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSE• <br />PLOMBINO CONTRACTOR MAIL ADDRESS CITI ZIP PHONE LICENSEL <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />ALUATION OF WORK ICOST OF MATERIALS PLUS LABOR, <br />USE OF BUILDING� <br />�-+'� C-F\ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR AIIACH FOUR COPIESI <br />LOT_BLOCY_OF -- -- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WOPK 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 />ANYOTHER STATE OR LOCAL LAW H EGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE qp <br />X O I�/ <br />PROJECT ADDRESS — <br />a117 <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />V1ATtR CLOSET (TOILET) <br />AIC - MHNDLG UNITS — H P <br />BATHTUB <br />REFRIGER.• , ION UNITS — H P EA. <br />LAVATORY ( WASH BASIN! <br />8OIL9IS — B. T.0 /H P. <br />SHOWER <br />GAS FIRED A C. UNITS — B T U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS — B.T U. M EA. <br />DISHWASHER <br />WALL HEATERS —BT. U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />_ <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOODSTOVE <br />_ <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />IIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />31 <br />TOTALFEE <br />3_ v <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />BUILDING <br />S <br />TYPE Or CONST <br />OCCUPANCYCROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLF.RS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICARONACC BY <br />PEARSONECKED BY <br />APPR. FOR ISSUANCE <br />BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RE5PUNSIBLe FOR DET enmlNlNG ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />