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`r.PPLICATION FOhs' <br />CONSTRUCTIONDITY <br />0theEOf <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION <br />O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />O SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />C-Lkal1 <br />ARCHITECT OR OF SIGNER <br />MAIL ADDRESS 113GIr' ZIP <br />PNONL <br />4l 11CIUL CONTRACTOn <br />MAIL ADDRESS CI1Y ZIP <br />PHONE <br />LICEIMA <br />F'�'S Nel,4i <br />B O7Jr fae 1 twAiN sf ►mF,Ruj v1A 9R242 <br />-7W-2- 1, G9HEAU-147? <br />D <br />MECHANICAL CONIRAf.TOR' <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBINR CONTRACTOR <br />MAIL ADORE'S CITY ZIP <br />PHONE <br />IICENSC• <br />CLASS OF WORT <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION_ <br />vALUATION OF W DR• COST OF IAAILRIALS PLUS LABOR( <br />I <br />sal-31ntl <br />��f isnCr rnN� <br />✓� <br />���v <br />4�� <br />r <br />DE SCRIBE won. <br />USE OF S NIG <br />S <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP <br />PLACATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS T YPE <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 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 />X l CV L ♦'.� 1'Y "_vc- { %x <br />LEGAL DESCRIPTION OI PROPER1115NOWN BELOW OR ATTACH FOUR COPIES <br />101_SLOCK_OF <br />_ <br />I <br />PROJECIADDRESS <br />Zt3 I MC <br />AP TS CITY SINESS LICENSE NO <br />01g1 8S <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <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 — FIT U /HP. <br />SHOWER <br />Pr <br />GAS FIRED A C UNITS — 0 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 />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />SACKFLOW PREVENTERS <br />j <br />WATER HEATER <br />5 <br />ROOF DRAINS — RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE — BAD. ETC) <br />METAL FIREPLACE B CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EYHAUCTFAN <br />SUB TOTAL f <br />SUB TOTAL <br />(1 <br />PERMIT f—it <br />PERMIT <br />TOTALFEE ! <br />1 TOTALFEE <br />O <br />InONl SE TBAG' <br />PLANCHECKNUMBER <br />H <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />IPA ZONE <br />I Of ANLA <br />VACANT SITE <br />ITYES FIND <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />h✓C OI COv51 <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE Of SLOG <br />NO Or STORIES <br />MAK OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />Al CIICAIION ACC BY <br />PLANS CHECKED BY <br />APPq FOR ISSUANCE By <br />PUBLIC WORKS <br />TOTAL <br />YHurcnl l v. __. <br />PROPERTY LINE LOCATIONS AND RELATED CASEMENTS. <br />