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1 <br />PPLICATION 1` <br />CITY 01 <br />`B'E"ro"'R <br />CONSTRUCTION <br />CVef" <br />everett <br />PERMIT <br />e <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />M.✓CI1Y Z <br />PHONE <br />Ew/. 7n. co. <br />MR5 4nyr;, ' <br />c S <br />_ b3/c <br />ARCIn1ECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />w�.ylic .S.tui lfto IdGWsn/ fyAvia✓os 9�oro <br />77� <br />_ .✓Ged <br />GENERALCONIRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONF <br />LICENSE. <br />litilLListiivLS <br />L�6�t�STa2crdr/o.cl J`�.2&r .5SV7 LrJF�t�Zo� <br />]s!3-/Yz <br />lul�ic. iG5�o4 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />7\ <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE :• <br />CLASS OF WORK <br />X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />,OV&u/ 2G1X 30 d4y2t wig/ •A%!"i 17.r.✓,G , /�<,Al'iAt/b f" 4WAnA0f04=.4e,4i <br />USE OF BUILDING <br />�,�� Slrf�.y��� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISION:, OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK W!LL BE COMPLETED WIT H WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AU FHORITY TO VIOLATE OR Cf.NCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFURMANCE OF CONSTRUCTION. <br />SIGNATURE OP CONTRACTOR OR AUTHORIZED AGENT CALL <br />X�iu `t�rr/ry <br />LEGAL DESCRIP1 ION OF P40PEMTYIS14OWN BELOW OR ATTACH FOUR COPIESI <br />LOT_l_BLOCK OF c�SIS \C�J.�� VIIEw / <br />PROJECT ADDRESS <br />3110 t, <br />APPLICAN FS CITY DUSINESS LICENSE NO <br />PLUMBING _ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE_ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H. P. EA. <br />/✓ <br />Q(J_ <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H. P. E_A. <br />SHOWER <br />GAS FIRED A . UNITS -TONNAGE EA <br />KITCHEN SINK A DISK <br />FORCED AIR SYSTEMS-B.T.0 NI EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-131. U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />_ <br />AIR HANDLING UNIT- CF. M_________ <br />_ <br />VACUUM BREAKERS <br />ROOF DRAINS- RAI NIL EADE RS <br />_STOVE <br />METAL FIREPLACE & CHIMNEY__ <br />_ <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL _ f <br />_1 <br />60 <br />PERMIT S <br />PERMIT_ 13 <br />_ <br />TOTAL FEE ! <br />-_ TOTAL FEE - S. <br />�T _ <br />THIS PORTION TO SE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRCNT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />EYES ONO <br />TYPE OF CONSt <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />V- i NR <br />64- <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAK OCC. LOAD <br />$82 5'r- <br />I <br />3 <br />FIRE SPRINKLERS REQUIRED ❑ YES 1 NO <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />APPB FON ISSUANCE LEY <br />!� <br />llu wl <br />L <br />PLAN CHECK NUMBER <br />39Gc� <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE.) /U <br />a of <br />VALUATION <br />$ <br />PT ND <br />:Sb <br />FEE <br />/�C7'.vTYr f--,Sim'='�,"lC,�Z 1t?z. FtilL7c�Z <br />l/qmljei r ��/ uUac�e r ua �7Ic,L 7-0f OFSTo urr <br />5'7UE �4L e6@&O •7?C-G Lk7'l <br />N x <br />0 <br />m <br />m O <br />B C <br />O <br />m <br />�H a <br />m <br />O <br />m <br />m <br />