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PLICATION FORS <br />OF city "R CONSTRUCTION `e <br />pT OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING YWECHANICAL ❑ PLUMBING ❑ SIGN <br />DWNER MAIL AODNL::S CITY JIP PHONE <br />All 1=Ab a T )C i D� I l �a� :2 50 CLw-rzr s ZOtI 353-40�(� <br />Ory PIP ruONE <br />GENERAL CONTRACTOR MAIL ADDRESS CI r!,I• PHONE LICENSER <br />\��••II�EE�CHILANICALCONTRACTOR( NAILAODRESS CITY DIP PHONE LICENSE <br />Y(,&U 00:11" 11V (*,S dos me.DD,AL,a4SL pve FLY-Qc& q?col OS9-y)9a VALE GI53L. <br />M tIUFpNnrJhNTFXCtOn MAIL ADOn[58 CITY JII PNoNE IICENSEI <br />CLASS OF WORK ❑ NEW ❑ ADDITION 9 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ W'OODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />PLUS LABOn, <br />-=_ )107L)L OE I1n I'li r S _136 <br />ufE DF euILDINa <br />LEGAL DESCRIPTION OF PROPERTY [SHOWN BELOW OR ATTACH FOUR COPIIISI <br />LOT— BLOCK- OF <br />� 100 n RTil <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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <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 OF CONTRACTOROR AUTHORIZED AGENT QRATE <br />PROJECT ADDRESS <br />-1'1ao <br />APPLICANI-4 CITY BUSINE SS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />Ifp, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILET) <br />A/C — A/HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H P EA <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H P. <br />SHOWER <br />GAS FIRED A.C. UNITS — 8 T.U. <br />KITCHEN SINK f OISP. <br />FORCED AIR SYSTEMS — B T U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B TM M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />• <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR ORAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK ISERVICE — BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL L'Y <br />PERMIT f <br />PERMIT <br />TOTALIKEE f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SEt9ACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO <br />OF DWFLIINfi UNITS <br />PLUMBING <br />SIZE Of BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPI ICATION ACC BY <br />PLANSC14ECKED BY <br />APPR FORISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />"HUYLIII T Vrrnuw rvm ncm vns.......... ..................�..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />