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rA. Er.rOFBER `B—. P P L I CATION FO.. <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />lblAl/�ILt i� PAESTdA� /q/o McOdgeaCL EU ETt 9g2o/ 94U-dSLO <br />R ITA RDElIONER M ILADD E!B CITY 21P PHONE <br />❑ SIGN <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />.se4 or <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />SEL F <br />CLASS OF WORK,I}7 .,/ <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCA-ION <br />VALUATION OF WORK ICOST OF MATERIALS PLU� LABORI <br />Ct <br />(D 000- <br />DESCRIBE WORN <br />RF_ DKnoih y OATH <br />USE Or BUILDING <br />N O M E <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A ^ERMIT 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APLI ANT! ITY BUSINE SS LICENSE NO. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />_ <br />LGT94-a_,LDCKqq0:GF ;VG F'fT DIUP <br />PROJECT ADDRESS <br />III 9/t W o aLc <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILET) <br />AIR COND. UNITS—M.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />Z <br />BOILERS—H.P. EA <br />_ <br />_ <br />SHOWER <br />U <br />OAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B. T.0 _ M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES CRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL • <br />PERMIT ! <br />PERMIT • <br />_ <br />TOTAL FEE • <br />In <br />O <br />1 <br />TOTALFEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK I REAR SETBACK I SIDE SETBACK I PLAN UHLCK NUMU y MO OcvoLD •^ 1 �I _ 111 <br />O`V• FEE RECEIPT NO <br />USE ZONE LOT AREA VACANT SITE �� � F <br />FEE6 VALUATION FEE OYES ONO <br />BUILDING <br />SIZE OF B100 <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPI ICATION ACC BY <br />0 <br />Pt ANSCHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />6 a.50 <br />