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s. XPLICATION FO.� <br />or(wOf " CONSTRUCTION <br />everett PERMIT E+ <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION O COMBINATION $ BUILDING <br />❑ MECHANICAL <br />O PLUMBING <br />❑ SIGN <br />OWNER MAIL ADDRESS ��11 <br />%r7R= I- CA,t�F,L/�F V�l T�yL, /72-E '�AvieTz/7�2=T <br />CITY ZIP <br />E12-r.-e->'r - FT 7z:ol <br />PHONE Afn.p <br />A tl,-A- <br />c Z <br />zrz.-3i73 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONIRACTOR MAIL ADDRESS CITY ZIP PIONS LICENSE• <br />tit//7- <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR PL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS ILAAB�O)RI <br />ES r,I.nf r yJV <br />DESCRIBE WORK. <br />RET�P« 2 Y /Je!>- u..;x. il,:+......a.. n. ..o., w:.e... .G... F'., r'e.. sea✓ <br />USE OF BUILDING <br />S�n-� E E= rip -- 77 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN <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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />X el <br />.CANTS <br />se ,F'f�Aov. <br />. G ALUESCRIP110N OF PROPERTYIS OWN BELOW OR ATTACH FOUR COPIES) <br />T r Lo lBLO K-IL 0 F- <br />LOT— DT✓'+Fav (A <br />PROJECT ADURESSpp <br />APPLICITY BU�FNESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOJIPMENT <br />FEE <br />WATER CLOSET ITOILET) <br />I <br />AIR COND. UNITS-H. P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />_ <br />BOILERS-H. P. EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />-_ <br />KITCHEN SINKS OISP, <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />_ <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 />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK(SERVICE-BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUB TOTAL <br />SUB TOTAL 3 <br />_ <br />PERMIT 2 <br />PERMIT <br />__ <br />_ <br />TOTALFEE f <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />T RUNT SETBACK <br />REARSETBACK <br />N.A. <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Ll� 1 •J <br />PLAN <br />FEE 5v <br />CHECK FEE <br />RECEIPT NO Z/ <br />L <br />IISL ZONE <br />LOT ARLA <br />VACANT SITE <br />DYES mo <br />FEES <br />UATION <br />FEE <br />TYPE OF CONST <br />�_ 0 <br />OCCUPANCY GROUP <br />R-3 <br />NO OF DWELLING UNITS <br />-- <br />BUILDING <br />SIZE OF FRUIT <br />N•Q• <br />NO OF STORIES <br />Z <br />MA%OCC LOAD <br />^ <br />PLUMBING <br />FIRE SPRINKLERS REOUIRED <br />❑ YES XNO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPI )CATION ACC BY <br />M <br />PLANS CHECKED BY <br />\c <br />APPR. FOR ISSUANCE BY <br />L C <br />TOTAL <br />