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APPLICATION FO._ <br />IME»FOm^ CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />Ilk NEPAL CDNIRONACTDB MAIL ADDRESS CITY I'll PHONE LICENSE• <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY 111, PTIONE LICENSE <br />PLUM91NO CONTRACTOR MAIL ADDRESS CITY TIP P140NL LICENSE• <br />❑V NEW ErADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAI UANON OF WOPn ICOST 01 MATERIALi PLUS LABORI <br />z, o00 <br />DF ICRIpE WORw / —f—� Ev�� '�—� � '� I ^"^ • .—v- ��• f <br />'A: �T�� // I � �"a,'a t>va/l—�6a?CrT�c. IL_lp-= Tu E�3i.G1�"i_TD '� Rr. L►.1 F4Etil�r <br />USE DI NUILERNO A <br />' A I <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED TIIIS.-IP- <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 F CONTRACTOR OR AUTHOR TIED NT OAIE <br />X <br />1 n L RI ION p, ROgA ♦IANOWN OIOW OR AITAE:11 IR41R COPVAI <br />tOI_ILOCK--DF <br />PROJECT ADDAE!! <br />17�241 15"C <br />APFLICANT4 CHY RUSINLSSL LN1F Np <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS - B.T U./H P. <br />SHOWER <br />GAS FIRED A C. UNITS - B.T.U. <br />KITCHEN SINK S DISP <br />FORCED AIR SYSTEMS - B T U. M EA. <br />DISHWASHER <br />WALL HEATERS - B T U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC 1 <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTALFEE <br />TAUNTS IDACK <br />PLAN CHECK NUMBE R <br />1ss33 <br />FEE <br />was <br />RECEIPT NO. <br />�toas I <br />BEAR SFTPACn <br />SIDE SETBACK <br />USE zONE <br />LOT AREA <br />VACANT SITE <br />OYES MO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Olt C.WJSYy <br />�xl <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />o <br />PLUMBING <br />SIZE w BLCG <br />NO OF STORIES <br />N <br />MAX OCC LOAD <br />/N� <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES NO <br />STATE BUILCING SURCHARGE <br />STATE ENERGY SURCHARGE <br />AI4'I.ICA1104 A(I r, BY <br />PI ANS OILOKED BY <br />APPR FOR ISSUANCE BY <br />L - C. <br />PUBLIC WORKS <br />TOTAL <br />/' t-,lf <br />A1�171 <br />%.. .PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AIL <br />F,t Polk' � Q� LiLA.I(_ o PERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />