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CITYOF <br />everett <br />BUILDING DEPARTMENT <br />259.8745 <br />..PPLICATION FO, ' <br />CONSTRUCTION <br />PERMIT,, <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />I] DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL &OLUMBING ❑ SIGN <br />OW f,Js A24 MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DES) NER MAIL ADDRESS CITY ZIP PHONE <br />01-1 CONTRACTOR MAIL -- CI1V 21P PNONE LICENSE <br />WL"c NMAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBWO CONTRA51OR Z MAIL ADDRESS CITY ZIP PIIONE LICENSE• <br />I <br />Iff NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALIIATION OF WORKICOST OF MATERIALS PLUS LASORI <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 />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 PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />AN'Y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />CIONATURE OF CONT ACTOR OR AUTHORIZED AGENT DATE <br />X J 7 oz � A T <br />APPLI NTS CITY BUSINE SS IJCE ENJ <br />P, L 1, -I !7 7 Aar <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_eLocK__oF <br />S <br />PROJECT ADDRESS <br />l 3�12o F/ayEf .(i — <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT FEE_ <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />WATER CLOSET(TOILET) <br />AIRCOND. UNITS —HP. EA. <br />BATHIUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY WASH BASIN) <br />to <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <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.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK (SERVICE —BAR. ETC. <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />TT <br />SUBTOTAL <br />PERMIT f <br />/ e <br />G <br />00 <br />_SUBTOTAL f <br />PERMIT f <br />iY <br />TOTAL FEE fL4D <br />Do <br />TOTAL FEE f <br />�_ <br />7 V <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING DEPT. <br />PERSONNEL <br />FRONT SETBACK <br />I REAR SETBACK <br />I SIDE SETBACK <br />I PLAN CHECK NUMBER <br />I <br />PLAN CHECK FEE <br />ZONE <br />OF BLDO <br />Be <br />rA <br />OCCUPANCY <br />VACANT SITE <br />OYES ONO <br />NO. OF DWELLING UNITS <br />BUILDING <br />MAX. OCC. LOAD <br />FOR ISSUANCE BY <br />OTHER <br />PENALTY <br />TOTAL <br />iFEE RECEIPT NO <br />FEES IVALUATION FEE <br />