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�-„'PPLICATION FOB <br />CI EOF N"' <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING fa MECHANICAL <br />CITY <br />WkUMBING <br />❑ SIGN <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A ' <br />MECNA ICALCONTRACTOq MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />A�A7Cteal- C-Yv}S ,�7i(iin 1&,T `� /YYtci IU ��c(cr� � ✓Z2 a''�8h/ .4)wY n -- <br />muuemnfnNTRR'TnFi MAIL ADDRESS CITY P PHONE LICENSE yj <br />CLASS OF WORK I <br />❑ NEW ❑ ADDITION M ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSEP.T El BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR( <br />DESCRIBE WORK c I <br />USE OF BUILDING <br />Qom, -I <br />�7 <br />it-/,Cl <br />I HEREBY CERTIFY THAT I FAVE READ ANU EXAMINED THIS AP - <br />PLICATION AND KNOWTHE SAME TO BETRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING TH ISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRA KING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFIOVISIONS OF <br />ANY OTHER STATE OR UXAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF'CD TRACTOR OOR AUTHORIZED AGENT DATE <br />X `/ <br />LEGAL OESCFtTION ROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT— BLOCK —_OF_ <br />PROJECT ADDRESS <br />SP,-i�-tC <br />APPLIC NTS CITY BUSINESS LICENSE NO <br />_ <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 />A/C - A/HNOLG 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.U. M EA. <br />DISHWASHER <br />WALL HEATERS •-B.T.U. M <br />LAUNDRY TRAY <br />I UNIT HEATERS - B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />_ <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />SACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.) <br />METAL FIREPLACE B CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EAHAUSTFAN <br />/ <br />011LU L.7 CC (CC H' <br />BUS TOTAL <br />f <br />BUD TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONSi <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SKE 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 />PLANS CHECKED BY <br />APPR. FOR ISSUANCE By <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />