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I <br />APPLICATION FOPthe EYEFER <br />CITY OfOf FfrMB <br />CITY CONSTRUCTION ®. everett PERMIT <br />BUILDING DEPARTMENT 269•8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ,MECHANICAL PLUMBING ❑ SIGN <br />AIL ADDRESS <br />PHONE <br />IENERA7LCONTRACjOR�/�� A%i ♦O��/' / /J /� /^ CI ZIP <br />y NE j�ENSE• <br />/%z TJ'1 Yf�ffbT V p((� L/ (IO DT Y/3/LI�P PCN�O �_S7 J'[EN! <br />AECHANIr LCONTRACTOR MAIL ADDRESS <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAII ADORE99 CITY TIP PHONE <br />;LASS OF WORN <br />❑ NEW ADDITION ❑ A TERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />/BiVST#G L �S W EB 1�1l / £Q 1C� E7+� �+eIi�'� <br />uBE Of tBU�IL/DIND' ` r��A I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />S�/�L7K'i FAV" PLICATIONAND KNOWTHESAME TOBETRUEANDCORRECT.ALL <br />LEGAL DESCRIPTION OF PROPERTY 1-—BE LOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />Lot_BLOCK­ OF 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 />I APPLICAN rS CITY PUSIKSS LICENSE JIO <br />oo&vim <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 ITOILETI <br />A/C — A/HNDLO UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />1 WASH BASIN) <br />BOILERS — S.T.0 M.P. <br />LAVATORY <br />SHOWER <br />KITCHEN SINK B DISP. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SYSTEMS — B.T.U. M EA <br />DISHWASHER <br />LAUNDRY TRAY <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />VENTILATION FAN <br />RANGE N PO <br />WATER HEATER <br />WOOD STOVE <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />SINK (SERVICE — BAR. ETC I <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL <br />PERMIT <br />PERMIT S <br />TOTALFEE S <br />TOTAL FEE <br />REAR SEtBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />OYES ONO <br />PLAN CHECK NUMBER <br />FEES <br />FEE <br />VALUATION <br />RECEIPT NO. <br />FEE <br />ARONT SFT_0j(5'= <br />USEZONE <br />BUILDING <br />$ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLOO <br />NO Or STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPP rOR15SUANCE BY <br />PUBLICWORKS <br />TOTAL <br />c cno ncTPRMININR ALL <br />rnvrc.n I .......... . __.__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />