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",ir.PPLICATION FONS,the lYETFB <br />CI <br />TY ofPL"R <br />FY CONSTRUCTION <br />COF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.81310 TO BE COMPLETED IN INK. PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ,15 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN R MAIL ADORES$ CITY PHONE <br />i `�1M-TC�'c rc r V T - S/ut>7 <br />f v _Z� EF' •.�'.e T t_ L (Frl •� <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CIIY <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />PLUMBING CONTRA TOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS O. WORK <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ID WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF R. ,COST OF MAILRIALS PLUS LABOR, <br />DESCRIBE WORK <br />jr -! 1,1. F. Car.. <br />USE OF BUILDING <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />,I r• ;c{n,.LE <br />PLICAT ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTIONOF PROPERLY ISHOWII BELOW OR ATTACH FOUR COPIES) <br />JIf <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOI�BLOC K—� of 1 r nVC Z <br /><S <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />I --,5 <br />ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />0u ._ �� O <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPLICANTS CITY BUSINESS LICENSE NO I <br />PROJECT ADDRE SS <br />1' <br />MECHANICAL <br />PLUMBING <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,HNOLG UNITS — N.P. <br />REFRIGERATION UNITS — H P EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS — S.T.U.rH P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />SHOWER <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />KITCHEN SINK 6 OISP <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 />DRINKING FOUNTAIN <br />VENTILATION FAN <br />RANGE HOOD <br />FLOOR DRAIN <br />BACKFLOLV PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />) <br />SINK (SERVICE — BAR. ETC I <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SUBTOTAL ! <br />BLAB TOTAL <br />PERMIT ! <br />PERMIT <br />TOTAL FEE ! <br />TOTAL FEE <br />FLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />. FONT SE-dArL. <br />USE LONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />S <br />OYES ONO <br />BUILDING <br />M1PE OL CD45t <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />PLUMBING <br />SIZE OF B,DG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLEPS REQUIRED ❑ YES O NO <br />STATE ENERGY SURCHARGE <br />_ <br />AP1'11CAUM+ 1;�. B. <br />P,. 1NG CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWOR KS <br />TOTAL <br />....cni. ........... _ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />