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the EYIIEFNR <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />KPPLICATION FOL._J <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION O COMBINATION <br />K6 �N E.1�'�A r,11LJEss IAIUOkRQD <br />"KNIIECI OR OkUIONER <br />❑ BUILDING O MECHANICAL ❑ PLUMBING <br />Ile N <br />I0exr%IIsvLIl - w4 ( 0 <br />❑ SIGN <br />OENEPAL CONNIACtORMAN ADDRESS <br />CITY IIP PIn ANT LICE 45f <br />ZIP Pln'NL LICI'IV <br />MECHANICAL CIXAOIOR <br />MAlL AD0Rk9B f,IIY <br />P.WNE <br />PLUMEINO 00NTRAC 10R <br />MML ADUR[SS GTY bl` III.IJI�L <br />CLA F WORK <br />NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL111ON ❑ WOODSTOVElFRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WO!K .CO51 OI 0.1 A I I mALS PLUS LABOR( <br />:�. 4 c_- v <br />1 I <br />DE BCR19E WAR ( � Sl "'^ wL 1SS <br />1`C I Cl�-aM COYJ l til�U� <br />AP - <br />USE Dr• IND I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND COAREC T ALL <br />DEL(IW OR Al1ACN (OUR GOPIt51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LWAL DEBCRIPIION OF ROPERIY191OWN I[D HERE- <br />OF WORK BE COMPLETED WITH WHETHER <br />TO <br />. TI I ES NOT PR <br />IN OR NOT. TIIE GRANTING <br />On CANCEMIT L <br />THE PROVISIONS <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />TOVVIOLATE <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />VV A <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAU EOFCONIRACTONDBAUTIIORIIFDAGENt T`aT <br />X <br />APPLICANTSCI <br />YBUSINESSUCL O <br />PROJECT <br />ADDRESS <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FEE <br />FOUIPMENT <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />qlC — AOINOLG UNITS — H P <br />RE FnIGERATION UNITS — H P EA <br />WATER CLOSET ITOILETI <br />BATHTUB <br />BOILERS — B.T U IH P <br />LAVATORY IWASM BA)I 41 <br />GAS FIRED A C. UNITS — B.T.0 <br />f <br />SHOWER <br />FORCED AIR SYSTEMS — B.T U. M EA <br />KITCHEN SINK ► DISP <br />DISHWASHER <br />WALL HEATERS — B.T.U. M <br />UNIT HEATERS —B.T U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE MOOD <br />FLOOR DRAIN <br />WATER HEATER <br />BACKFLOW PREVENTERS <br />WOOD STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR ETU) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />SUB TOTAL E <br />PLAN <br />PERMIT <br />TOTAL FEE <br />CHECK NUMBER FEE RECEIPT NO <br />PERMIT E <br />TOTALFEE E <br />IPUNi SETBA___CK <br />RLAR SETBACK SIDE <br />SETBACK <br />FEES VALUATION FEE <br />ustloNt <br />IOI AREA <br />VACANT <br />SITL <br />RYES <br />IlNO <br />BUILDING <br />TYPE OF <br />CONST <br />'l'. CUPANCYOnOUP <br />NO <br />OF DWELLIND UNITS <br />PLUMBING <br />SIZE OF SLDO <br />1411 OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REOUIRCD U YES O NO <br />STATE BUILDING SURCHARGE <br />7 <br />3 <br />S <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPLICAIIONACC BY <br />PI ANS GrtCKLO BV <br />AI'PR ( OR155UANCE BY <br />TOTAL <br />_ <br />nm oc ACV RESPONSIBLE <br />FOR DETERMINING <br />ALL <br />PROPERTY LINE LOCATIONS AND RELATED LAatMtn TO- <br />4- <br />