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APPLICATION FLR <br />IINT <br />CITY OFCONSTRUCTION <br />CITY OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRIN" <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />k <br />ED <br />❑ PLUMBING ❑ SIGN <br />GENERAL CONTRACIOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE . <br />C'o"I 1 �`1Srs/ <br />�i�.s�,"7 <br />CI�Do4 <br />753GO�e' D27.0L2E�1/1y-�1� <br />1�LIfaN'e <br />MECHANICAL CONTRACTOq <br />MAIUOORESS <br />CITY <br />ZIP <br />PIIOtE <br />LICENSE A.J�y)J <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />CLASS OF WORK <br />—NEW ClADDITiON ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION [I WOODSTOVE/FRPL.INSERi DUILDING RELOCATION <br />ALUATION OF WORK (COST CF MATERIALS PLUS LABORI <br />OESC IDE WORK <br />USE OF BUILDING <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 OPERTYISHOWN BELOW OR ATTACH FUUR COPIES( <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDIIERE- <br />/� LA- `/�- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT� aLoclL._-GF <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 />- <br />SIGNAT RL QF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPU ANTS CITY DUBINEBS LICENSENO <br />PROJECT ADORE SS <br />�(J �i4�1C ET <br />LA I <br />MECHANICAL _---- <br />PLUMBING ----�— <br />TYPE OF FIXTURE <br />I FEE <br />FEENO. <br />_ <br />CX�. <br />UNITS-EA.I <br />.91 WATER CLOSET(TOILET) <br />RATION UNITS-H.P. EA/L <br />BATHTUB <br />LAVATORY(WASH BASINI <br />CJT-H.P. <br />LNO.TYPEOFEGUIPMENT_TYPEOFEGUIPMENT <br />EA. _SHOWER <br />ED <br />AC. UNITS -TONNAGE EAKITCHEN <br />C7O <br />AIR SYSTEMS -BTU. MEA(90 <br />SINKR DP. <br />CXJATERS-B.T.U.MLAUNDRY <br />DISHWASHER <br />M <br />TRAY <br />�L <br />_ATERS-B.T.U. <br />ex) <br />COOLERS <br />/ <br />CLOTHES WASHER <br />_ <br />O <br />CLOTHES DRYERS -- S� <br />/ <br />WATER HEATER <br />_ <br />I VENTILATION FAN <br />URINAL <br />) RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />_ <br />VACUUM BREAKERS <br />STOVE -- <br />METAL FIREPLACE R CHIMNEY <br />ROOF DRAINS-RAINLEADERS <br />INSERT <br />SINK (SERVICE -BAR. ETC)WOODSTOVE/FIREPLACE <br />UU <br />'TJ <br />SUB TOTAL 5 <br />SUB TOTAL <br />PERMIT III <br />PERMIT <br />S <br />UEL7 <br />TOTAL FEE S <br />L <br />O U <br />TOTAL FEE <br />$ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SE�LB�A.,Cr� <br />�v <br />PEAR SE DA� Dr <br />SIDE SE�C� J <br />P�N�EG /� �� <br />FEE �� .J a' <br />VALUATION <br />RECP JNN O� <br />3FEE <br />-- <br />USE ZONE LOTAREAA VACANT SITE FEES <br />RYES ONO <br />TYPE OF C..ON11 ST. OCCUPANppCY GROUP1 ,I NO.OF OWELlINO UNITS <br />1`� 1�.3 M I BUILDING <br />CIL <br />s Qj <br />SIB 3F SLOG S. F NO. OF STORIES <br />Al = -T-'1? `+• <br />��� <br />FIRE SPRINKLERS REQUIRED ❑ YES NO <br />MAX OCC. LOAD <br />�, <br />PLUMBING <br />MECHANICAL <br />OTHER <br />QQ <br />LJU <br />I <br />PENALTY <br />APPLKAIIONACC. BY <br />PLANSCHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />V <br />S� <br />.� `� <br />tTU�/rl <br />l.. • L. <br />Z <br />O <br />