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APPLICATION FOE. <br />���,�„ <br />CIT OF <br />CITY of <br />CONSTRUCTION <br />e <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION <br />❑ COMBINATION �Q BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OW Nf:R <br />yAkJUk/b �£Fs <br />MAIL ADDRESS CITY ZIP <br />N �AR4li7T� /7TS //-,()/ -5.10 &£ sF• QW FGC,P£T7 <br />PHONE <br />rff.)0V ,35�7 4'y97 <br />4RLHITECT O UE SIGNER <br />kmtAsF/V <br />MAIL ADDRESS T CITY ZIP <br />,� U• <br />PHONE <br />1�l <br />GENERAL CONTRACTOR <br />A,-"..,_ r /.___ <br />,1�� ;;]]MAILyyADDRESS //)/ cCI[TY ^^ / ZIP nn <br />/`YJnL.� Ar { iJlS WO �['U/YUF dC 31. &,moc77 1/4 9Vod,3(17J997 <br />ONE <br />C[ SE <br />MECIIANICAI CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE IICL14SE• <br />NEW ^-❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRFLANSERT ❑ BUILDING RELOCATION- <br />LUATION OF WORK ICOST OF MATERIALS PLLIS LABORI <br />,1 o a orru , uT� <br />OE SCRIBE OAK ^ <br />N C-LV A.-C.>• M /J r f I t r <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 LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERTY/ISHOWN BELOWORATTACH FOUR COPIES) <br />a' M/)O /{OP Ki /}s <br />PFon <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />r]CF <br />COI_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 />/ <br />d J 1,4Gaao <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />J7 <br />Oi(t/II E y� Gf /]IRIS U/1 �JLIE <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />T <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LiF 5 U U <br />X l0%s1y7 <br />4 aiC <br />PROJECT ADDRESS <br />APPLICA r I BUSINES'S LI ENO <br />N931 /iolrbor, �9n� <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 />171; <br />A/C - A,HNDLG UNITS — H.P. <br />BATHTUB <br />/ <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY (WASH BASINI <br />BOILERS — BAT U M P <br />SHOWER <br />GAS FIRED A C. UNITS — B.T.U. <br />1 <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.TU M <br />CLOTHES WASHER <br />Q <br />EVAPORATIVE COOLERS <br />URINnL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR OF AIN <br />RANGE HOOD <br />BACKFLOVPREVENTERS <br />WATER HEATER <br />ROOF DRAIAS—RAINLEAOERS <br />WOODST_ VE <br />SINK ISERVICE —BAR. ETC) <br />MLET FIREPLAC HIMNEY <br />DO <br />FIREPLACE INSERT <br />HEAT PUMP <br />_ <br />GAS PIPING <br />EXHAUSTFAN <br />ETOTALIFEE <br />OTAL f <br />SUBTOTAL <br />PERMIT <br />T f <br />S <br />110 <br />TOTALFEE <br />PLAN CH E K NUMBER <br />FEE <br />3(� <br />RECEIPT NO. <br />9 3q R& <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />sue ' <br />zs' <br />�7 1 <br />�Lf <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />T�1 �_3 <br />ES ONO <br />BUILDING <br />A�FA, <br />(F[J <br />ni <br />�f• <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UIdTS <br />(A <br />R-3 <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />All <br />MECHANICAL <br />` <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES O <br />STATE BUILDING SURCHARGE <br />3 <br />(J' <br />STATE ENERGY SURCHARGE <br />APPI (CATION ACC BY <br />PLANS CHECKED BY <br />APFR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />I-�Y <br />�/`i <br />elf. <br />I.�(c.�•prJ <br />KIIKIF_ AI I <br />rnvrc nl I VYYIYCnJ-­" _- <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />