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,Tw PLICATION FOP EYEF!„ <br />OF CITY "'R CONSTRUCTION e <br />CITY oP <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ,E�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS ,� p CITY ZIP PHONE <br />iL&-12 rFz)beorI inn •�3-� yjnc/f'etE-//eyyeteIt91i.�ib/ <br />MAIL ADDRESS C TY ZIP PHONE <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE IF <br />GENERAL CONtnACTOn <br />��D�Y <br />44P.S�.41'2Ar <br />COn% <br />pha <br />MAIL ADDRESS <br />CITY LIP <br />PHONE LICENSE <br />MCCAANICAL CONTRACTOR <br />...e: ADD14CSS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR <br />CLASS OF WORM <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />VALUATION OF WOR+ICOSI OF MLITERALS PLUS LABOR. <br />, r�4 <br />W+M jA. �'I ILA fjLtil 1CtU GLY1.N6144V>7I Q_a A" JIM <br />REPAIR ❑ DEMOLITION Cl WOODSTOVE;FRPL.INSERT ❑ BUILDING RELOCATION <br />ueE of euILOINo <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S/� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BlLOW OR Al1AGN FOUR COPIES. <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />FILOCK­ OF <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NO'i PRESUME TO <br />LOT- <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />AA <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACT(?OR AUTHORIZED AGENT DATE <br />X &,,,,J*� "Z - / - Isle <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PROJECT ADDRESS <br />Al'IL <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A C - AZHNOLG UNITS <br />REFRIGERATION UNITS - H P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN. <br />BOILERS -B.TU/H P. <br />GAS FIRED A C. UNITS - BT.U. <br />SHOWER <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />KITCHEN SINK A DISP <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />UNIT HEATERS-S.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />RANGE MOOD <br />FLOOR DRAIN <br />13ACKFLOW PREVENTERS <br />WATER HEATER <br />NS - RAINLEADERS <br />WOOD STOVE <br />FIREPLACE A CHIMNEY <br />ETC)METAL <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />,R4FDlAIff <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />TOTAL FEE <br />PI -AN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />READ SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACA)?ITE <br />FEES <br />VALUATION <br />FEE <br />OYES NO <br />BUILDING <br />S <br />TYPE OF ST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />R- 5 <br />PLUMBING <br />SIZE OF BLDG <br />NO OF StTORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES A�NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPUCATIO'I ACC/BAY <br />PLANSCHECCKKE�EDDBY <br />/✓✓//DD�� <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL --_ <br />...... I-— A„, occonucl Rl F mR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />