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APPLICATION FOR-'' <br />CITY OF <br />CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8810 <br />❑ BUILDING ❑ MECHANICAL <br />O DEMOLITION ❑COMBINATION lIP <br />y 1CITYr.E p MuI ADDRESS � NE AEI 1�1./J�1`�— <br />"`:_r�ta s-rnIJrJESS Boos-l2 <br />Cnr NR <br />MAIL .RUREss •N 1 W L Q <br />3ao5 --1�A� <br />O PLUMBING <br />r <br />❑ SIGN <br />sE.11ld wa &Ea G9-4A <br />jIP 1`I Ii�NL IIL:I -LEI <br />PIK.NT III INS- - <br />❑ BUILDING RELOCATION <br />.SOFw [IO <br />RP❑ ADDITION Cl ALTERATION REPAIR ❑ DEMOLITION ❑ LVDSTOVE/FRPLANSERT <br />0 <br />_..___._.. ,.. ...new .rnS11P -l• 11..... f11'LLIS LABOHr <br />1 <br />r �wL NG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED <br />141S AP <br />PLICAT ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />F LAWS AND ORDINANCES GOVERNING THIS TYPE <br />'aw" "oo, Or PROPERT♦ 19NOWN SET OR A I I AON�R CL' OF WORK WILPROVISIONS OI. BE COMPLETED WITH WHETHER SPECIFIED HE E- <br />a I GIVE <br />AUTHORITY <br />RITY THE VIOLATETING OF OR CANCEL <br />THE <br />PROVOT ISIONS <br />TO <br />OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />VLo1..LsNE P/u4Eg ANYOTHERSTATEORLOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. IE <br />A L) Q SIGN LURE OF CONTRACTOR OR AUE 12FD a`,�E NI <br />�C6lC r x <br />� <br />r .4 a6i1 QMIS �� 1 APPnf.ANt DIIr BUSINESSIIff NSE NO <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR REM <br />-- <br />AIO — AIHNDLG UNITS — H P <br />NATE11 CLOSET ITOILETI <br />REFRIGERATION UNITS — H P EA <br />BATHTUB <br />BOILERS — 8.T U IH P <br />LAVATORY (WASH BASIN) <br />GAS FIRED A C. UNITS — B T.0 <br />SHOWER <br />FORCED AIR SYSTEMS —BTU. M EA <br />KITCHEN SINK B DISP <br />WALL HEATERS — B T U. M <br />DISHWASHER <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 HOOD <br />FLOOR DRAIN <br />WATER HEATER <br />BACKFLOW PREVENTERS <br />WOOD STOVE <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK ISERVICE — BAR. ETC ) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />!UB TOTAL <br />! <br />PERMIT <br />PERMIT <br />TOTALFEE <br />TOTAL FEE <br />! <br />SIDE SETBACK <br />VLAN UH CK NUMBE� FEE RECEIPT NO <br />EI l'K NLAP � SEIB.CK� <br />/ <br />S <br />� (l-`/FEES <br />- Zo <br />-- <br />VALUATION FEE <br />IOI AREA <br />VACANT 9111 <br />LIVES UNO <br />FEES <br />BUILDING S <br />COAST UCCUPANCr GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SLOG Nn OI 510RIE9 <br />MAX OCC LOAD <br />MECHANICAL <br />OTIIER — <br />BUILDING SURCHARGE <br />IPRINKLERS REQUIRED U YES ONO <br />STATE <br />E ENERGY SURCHARGE <br />STAT <br />rI.+NS GIEGALO RY <br />API'N l0Ni5SU.NCL IT' <br />PUBLIC WORKS <br />TOTAL <br />RESPONSIBLE DETERMINING ALL <br />OWNERSPROPERTY <br />PROPERTY NE LOCATION 5 AND RELATED EASEMENTS <br />A <br />