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S�`rVPLICATION FOI:!' <br />`e <br />°"'" <br />CRYOF <br />CITY <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ClBUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />�d i6e)1U <br />24 z/ eJ .eftt- <br />34S63zC <br />ARCHITECT OR DESIGNER <br />MAIL ADOPESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE •' l0 (F <br />LICENSE <br />i�......ADDRESS <br />p%/IrJAC'O t Z r� Z <br />>7%Y r �. <br />GSkF l� <br />_....._...�.....s.....—T <br />MAR ADORE54 CITY 21P <br />PNONE <br />LICENSE4 <br />LICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPL. INSERT ❑ 13UILP,ING RELOCATION <br />VALUATION OF WORK ICOST OF MATEI IALS PLUS LABOR) <br />n L _ ^V �. , .. , � l._a:lr.•r.E,.c �L,�.,Kcs .l0 GQ LS �- /t/o t GJI! tf•� t/9.t/k <br />usE OF BUILD <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 />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOWORATTACH FOURCOPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />I <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />( <br />I <br />PROJECT ADDRESS <br />APPLICANT'S CITY BUSINESS LICENSE NO <br />e/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />i •' <br />WATER CLOSET ITOILET) <br />MC — AMNDLO UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS —H.P. F.A. <br />LAVATORY ( WASH BASINI <br />BOILERS — B.T. U.M.P. <br />SHOWER <br />OAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK A OISP. <br />FORCED AIR SYSTEMS — B.T.0 0 M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />' <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />' <br />! <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />1 <br />URINAL <br />CLOTHES DRYERS <br />• <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN - <br />RANGE HOOD <br />i <br />SACKFLOWPREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />I <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE f CHIMNEY <br />TI, <br />FIREPLACE INSERT <br />HEAT PUMP <br />I <br />GAS PIPING <br />'I <br />E%HAUSTFAN <br />CUB TOTAL f <br />BIN TOTAL <br />/ <br />PERMIT f <br />PERMIT <br />TOTAL FCC f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />FRONT SETBACK <br />'USEZONE <br />LOTAREA. <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />' <br />DYES ONO <br />S <br />BUILDING <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />"TEOFBLDG <br />., <br />NO. OF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED O YES ❑ NO <br />STATE ENERGT SURCHARGE <br />APPLICAIIONACC. BY <br />PLANSCHECKED BY <br />APPR. FOR SUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PHUVLHI Y UWNMMO Hn- nFQrvi.�•+.� • ..•• ..� • �• • ••• <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />