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`-AFPLICATION FOURthe eYerett <br />EYmyreen <br />CITY <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION 0 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY' ZIP' PHONE <br />38oz Co�Y TF✓�2g'1T- 987p� �ZS� 313C� <br />c4AAM (C)N PERSOt. <br />P�0.R-1T>F2S' <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITYZIP PHONE 7- <br />1 O� <br />� <br />S CITY <br />GENERAL MAIL ADDRESS ZIP PHONE LICENSE• <br />61DPiNC <br />MECRANICALCONTPACTO MAIL ADDRESS CITY ZIP PHONE LICENSE- <br />tI <br />PLU M D I NG CONTRA C TOR MAIL ADDRESS CITY ZIP PHONE IICENSEA <br />II <br />CLASS OF WORK <br />I-]NEWNEW ADDITION X ALTERATION ❑ REPAIR El DEMOLITION ❑ WOODSTOVE/FRPL.INSERT El DUILDING RELOCATION <br />VALUATION OF WORK (COST Of MATERIALS PLUS LABCRI <br />Zoo 00o <br />DESCRIBE WORN <br />1.E45P41OL-2 I M P�oV�n1 <br />ENTS o <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />�O F—= <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCNIPNON OF PROPOII Y IsuoWry n[Low <br />nnncn oun cor¢sI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />LOT -BLOCK --or <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />HE PERFORMANCE OF NSTRUCTION. <br />TURE OF CO FACTOR O. AU O IZED AGENT DATE <br />l2 g <br />LAP <br />PROJECT ADDRESS <br />NTS CITY BUSI :SSLICENSENO. <br />(� / <br />PLUMBING <br />MECHANICAL <br />NO. TYPE Otz FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPM ENT FEE <br />' <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />_ <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. Al <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />LOTHES DRYERS <br />Ck-- <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE CHIMNEY <br />_ <br />SINK (SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL 5 <br />PERMIT <br />S <br />PERMIT S <br />_ <br />TOTALFEE <br />S <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONTSETBACK REAR F-YBACK <br />SIDE SETBACK PLAN CHECK NUMBER PEA CHECKFEE <br />.� /C7957 FEE RECEIPT <br />_ Al . <br />VX r `/ 7 (� <br />USEZONE POT AREA <br />VACANT FEES VALUATION r <br />^A'1 <br />MA <br />NO <br />OYES ONO <br />TYPC Or CONST. OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />��'N Al', <br />16 BUILDING $G Lev(( i.� • b 83 oo <br />SIZE OF BLDG. NO. OF STORIES <br />MAX. DEC. LOAD <br />/J6O� (� �J ` <br />// J <br />13(5 PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES X <br />NO OTHER <br />PENALTY <br />APPLICATION ACC. BY 1LVISCHECKEDBY <br />APPR. FOR ISSUANCE BY <br />to �I x J <br />TOTAL <br />Ot3Tnru�,n u r�F�C-rt, s� •n"�zA-i� <br />