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V U,! L Itm- L(- 0 b <br />/'1 <br />o0le'(NS 351-0- <br />APPLICATION FO1. <br />!Y!1!R <br />CITE <br />of <br />cITYOF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PHONL <br />/Aw,Vf&CE <br />2232 !�`AKE2 �9✓C- Ea5Reff FPO" 15i-2 Con <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />/990/ A- pAvaFRS <br />PHONE <br />672-y309 <br />Jul YNF- >e°�I <br />GE ERAL CONTRACTOR <br />MAIL ADDRESS Cltt 111 <br />\ <br />"HONE <br />LICENSL • <br />E!/FRET/ SGVOoz_ D/S i <br />i ,HANICAL CONTRACTOR <br />MAIL Ap RLSS CITY ZR <br />PHONL <br />LICENSE <br />PLUMBINGCONTRACTOR <br />MAIL ADDRESS UTY bl <br />PHONE <br />LICENSE• <br />CLASS Or WORK <br />0 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTO'VL <br />cRT Cl <br />BUILDING RELOCATION_ <br />WLUATIONOFWORK,COST OF MATERIALS PL <br />LABORI <br />DESCRIBE WORK <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />b �-E F/l/HIA-Y '6✓ 5 <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LE AL DescRIRnOH or PROPERTY SHOWN BELOW Anna. rouR coPlEs <br />-6 BLOCN '_ OF.:jHEF41 r4�'%' A4 c r✓ <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NO -'RESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PF jVISIONS OF <br />ANY OTHER STATE OR LOI.AL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ���.k ,, 6-2-f�S/ <br />PROJECT ADDRESS <br />APPL CANTS CITY BUSINESS UCLNSE NO <br />I Cn to lAw �aa v <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />—� <br />WATER CLOSET (TOILET) <br />I Ct <br />A,C - AIHNOLG UNITS - )1 P <br />BATHTUB <br />RE'RIGERATION UNITS - H P EA. <br />LAVATORY (WASH BASIN) <br />COILERS - B.T U M P <br />SHOWER <br />GAS FIRED A C. UNITS - B T.0 <br />KITCHEN SINK <br />FORCED AIR SYSTEMS - B T.U. <br />/ <br />DISHWASHER <br />O <br />WALL HEATERS -B T. U. M <br />Q <br />LAUNDRY TRAY <br />UNIT HEATERS -B.T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />JL <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST AN <br />SUS TOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />TOTALFEE <br />CLAN CHECK NUMBER <br />FEE <br />'8 <br />RECEIPT NO. <br />/059 <br />vRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />c <br />USE ZONE <br />1 <br />LOT AREA <br />VACANT SITE <br />ES ONO <br />FEES <br />VALUATION <br />FEE <br />l <br />BUILDING <br />5 Z <br />i 3 <br />oo <br />TYPE OF CON T <br />U <br />OCCPAJNCY GROUP <br />NO OF DWELLING UNITS <br />L, <br />�L <br />♦ - A' <br />(_} - <br />PLUMBING <br />SIZE OF-BI�DG <br />N <br />2SCr,5-f- CNrr <br />NO OF STORIES <br />-2 f QV7 <br />/.7 <br />MAr OCC LOAD <br />/, / �T <br />V •�I <br />MECHANICAL <br />50- <br />OTHER <br />77 <br />Q2, <br />FIRE SPRINKLERS REQUIRED ❑ YES O <br />STATE BUILDING SURCHARGE <br />5D <br />STATE ENERGY SURCHARGE <br />1 5 <br />APPLICATION ACC B, <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />iU <br />^ <br />y�/7 <br />TOTAL <br />F, rl.ncTCOAII:dIMf-AII <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />