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1 <br />I <br />1 <br />1 <br />PLICATION FOO <br />The FFTNR <br />C"OFCONSTRUCTION <br />DITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 1 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION Q(COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OR <br />MAIL <br />evereN <br />e <br />❑ PLUMBING ❑ SIGN <br />LICENSE A <br />MECH CAL CONTRACTOR /01MAIL ADDRESS LHY L)P / PHONE 1� LICENSE • It <br />PLUMBING CONTRACTOR !MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OI MATERIAL5 PLUS LABOR) <br />� lsgsr� <br />DESCRIBE <br />V. - <br />USE o au INc <br />S <br />I HEREBY CERTIFY THAT I HAVE READ AND %AMINED THIS AP- <br />PL ICATION 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 OFA PERMITDOES NOTPRESUME 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. I <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIE <br />��y� �L�jy <br />LOTaEgRLOCK.LLJ_0F �F <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <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 />A/C - A/HNDLG UNITS - M.P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B.T.0 /H P. <br />) <br />SHOWER <br />GAS FIRED ABC. UNITS - B.T U. <br />KITCHEN SINK S OISR <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-R.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS - B.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 FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUE TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />$ <br />PERMIT <br />TOTALFEE <br />$ <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <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 CONS) <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF SF TRIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />— <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />YHVrLHI Y uwNcna/1n1: nCafVIYD)OlC rwn vc cnm.u.v nor <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />