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it <br />i <br />E <br />QOPLICATION FO1 <br />"F'""' CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK LEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING m,MECHANICAL <br />MAIL ADDRESS <br />�7, <br />e!Y!F!R <br />. <br />❑ PLUMBING ❑ SIGN <br />60"7 V <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F I <br />MAIL AOC E5S <br />MAR ADDRESS <br />CLASS OF WORM I <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICO5T OF MATERIALS PLUS LABOR( <br />C!,KAIBE WCr1 n_ <br />USE OF BUILDING <br />`* -�� C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORD I NANCES GOVERN ING 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 PROVISION;.' OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON, RACTOAUTHORI AGENT DATE <br />1 / <br />4 <br />LEGAL DESCRIPTION OF PAOPERTYISHOWN BELOWOR ATTACH FOURCOPIESI <br />LOT- BLOCK 0 <br />PROJECT ADDRESS <br />(� <br />J <br />APPLI 5 CITY BUSINESS LICENSE NO <br />PLUMBING - <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OR EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNOLO UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS —B.T.U/H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS — B.T.0 . I M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />- <br />LAUNDRY TRAY <br />I UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />' <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 />OAS PIPG <br />EXHAUSTINFAN <br />SUBTOTAL <br />/ <br />SUS TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />! <br />TOTAL FEE <br />FRONT SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAP SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONJ <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF LONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />312E OF BLDG <br />NO DF STORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPUCATIONACC RY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />rnurcm . V.n¢na nnv nw�....,...� ..-.. --. _........... _ ..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />