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the EY.rpENR ..PPLICATION FOE <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />'59-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />G DEMOLITION ❑ COMBINATION ❑ BUILDING 1!1 MECHANICAL O PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />")TC` <br />ARCHITECT OR DESIGNER ( AIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONiMCTOq MAIL ADDRESS CITY- ZIP PHONF. _ UCENSF• <br />1. �RII,UI«t L.IIkIcilU��`((((Ik(117, �I'(.li(f ,,i5,)'%'�l liI(�l'(�! ?.a� <br />PLUMBINGCONTRACTOR MAII AD RESS CITY ZIP PHONE LICENSE• V <br />❑ NEW Cl ADDITION O ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />USE OF BUILDING <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 THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <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 GATE <br />X AA <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW ORATTACH FOURCOPIES) <br />LOf_BLOCK__OF <br />PROJECT ADDRESS <br />I\ I ILL <br />APPLICANTS CITY BUSINESS LICENS NO <br />PLUMBING <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H. P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H, P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK B OISP, <br />FORCED AIR SYSTEMS—B. T.U�' <br />DISHWASHER <br />WALL HEATERS—B.T.U. _M <br />_ <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 />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />_ <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL ! <br />_ <br />PERMIT IT <br />_ <br />PERMIT ! <br />TOTAL FEE IT <br />_ <br />TOTALFEE ! <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK BEM SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK EEL <br />:1 —FEE RECEIPT NO <br />USE ZONE LOT AREA VACANT SITE <br />OYES ONO FEES VALUATION FEE <br />BUILDING <br />SIZE OF BLDG NO OF STORIES MAX. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED C YES ❑ NO <br />OTHER <br />PENALTY <br />APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br />TOTAL <br />S <br />