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5PLICATION FO& <br />FMEL+FiFMn <br />cIT OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION <br />O BUILDING ❑ MECHANICAL A PLUMBING ❑ SIGN <br />OWNER / <br />Arw 05o //� <br />MAIL AODRLS5 CITY 7"' PHONI <br />2/7 - /(70=` Sf. S A</, ze,14 l-7f 9 QfX1 <br />AICHHLCI OR DESIGNER <br />MAIL ADDRESS CITY ,i PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY I PHONE LICENSE R <br />MECHANICAL CONTRACTOR MAIL ADDRESS 41Y PHONE LICENSE R <br />PLUMBING CONTRACTOR MAIL ADDRESS c'Iv Z" PHONI LICENSER230-1 <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAiP ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT Cl BUILDING RELOCATION <br />VALUATION OF WORN (COST OF MATERIALS PLUS LABOR, <br />OF SCRIBE WORK <br />USE OF BUT DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF 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 NO 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 OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />IC APPLTS C) RUST SS LICE I:SF N <br />LEGAL DESCRIPTION OF PROOERTY SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK— OF <br />PROJECT ADDRESS � <br />203� 7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />15 <br />f7r,AIC <br />— A'HNDLG UNITS — H P <br />BATHTUB <br />REFRIGEPATI ON UNITS — H P EA <br />LAVATORY (WASH BASIN) <br />ZCD <br />130ILE8S-8.TU IHP <br />SHOWER <br />GAS FIRED A C. UNITS — B T.U. <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS — 8 T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — 8.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) <br />METAL FIREPLACES CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL <br />f <br />/ <br />OCi <br />SUE TOTAL <br />PERMIT <br />S <br />Q (7 <br />PERMIT <br />TOTAL FEE <br />f <br />0 <br />00 <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />I PONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT APEA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANC\'GROUP <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 SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPI (CATION AC':: BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE By <br />PUBLIC WORKS <br />TOTAL <br />PHUII Y UWNtHJ AMM nwrv11o1R11 ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />