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1'1 <br />;PPLICATION FOCI <br />The CI ED'°""' <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />269•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />CITY ZIP <br />❑ PLUMBING <br />EYEFER <br />e <br />❑ SIGN <br />I <br />ARCH( fiftT OR DESIO MAIL ADDRF 53 CITY ZIP PHONL <br />____.. _-............ MAIL ADORE55 CITY ZIP PHONE LICENSE <br />MEONAMOAL CO A OR MAIL ADDRESS CITY ZIP FHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS❑ NEW WORK <br />ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK(COST OF MATERIALS PLUS LABORI <br />11 ` EBCRIBE WORK 'Y, <br />1 <br />I <br />USKbFBUILDIHo 0 <br />• <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <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 />SIGN R OFCONTRA OR AUTHORIZfip AGENT DATE <br />8 <br />LEGAL DESCRIPTI of Pao RTYISNOWN BELO RATTACH FOUR COPIES( <br />LOT— SLOCK­ OF <br />PROJECTAOORESS <br />2s( r Amra <br />BUSINESSLICENSE NO <br />APPLICAN :�R6 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />MC — A/HNDLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY I WASH BASIN) <br />BOILERS — 6T.U,/H.P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK B 013P. <br />FORCED AIR SYSTEMS — B.T.U. All EA. <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 />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS—RAINLEADERS <br />WOOD STOVE <br />SINK [SERVICE — BAR. ETC.) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />iRONTSETBACK <br />REARSETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE Of CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />A� <br />PLANSC14ECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />nETERUININn ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />