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The EYuprMR <br />"--:APPLICATION Flak <br />evereft <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION El BUILDING ❑ MECHANICAL C <br />PLUMBING <br />SIGN <br />OWNER <br />MAILADDRESS CITY ZIP <br />PHONE <br />`,L;,�r=u''L�I <br />/�I�azTz-Pic-•� L�,r:l' IS'�I ��s i�.lr- tiIl�2�I�L!Ilr� <br />'IJ'2�� <br />LS'T•L.124 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />L-LTTU-12— 1-'l Y'i=C_Ci jlC—/d5 129 "1 I -I Lf �I i `•> tl)C('cTj CIS'csl �>�I129=1 •'> LE TT CP51Ga <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• I > <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF 1VORKR�--II <br />❑ NEW Ja ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OT WORK ICOST OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />4pD _23"X IC o ('/aNCL 7u i=K15 i I,UC> S7 K lLc�" ��Lti1 <br />USE OF BUILDING <br />�� �I? T Nj-1 <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 LAWS AND ORDINANCES GOVERNING THIS TYPE <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 OFe <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 �(ice.. ' .2y <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK —OF <br />PROJECTADDRESS r"N-i M`>.S L/\n117)1/oG <br />tv, fac,ss c a-,/3,I2LIs'II(-( - <br />APPUCANTSCITYBUSINESSLICENSE O. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <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 A.C. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. _ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT "HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORWIVF COOT. ERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS -RAINLEADERS <br />_ <br />METAL FIREPLACE & CHIMNEY _ <br />SINK (SERVICE -BAR, ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />� <br />�— <br />SUBTOTAL <br />SUBTOTAL <br />PERMIT ISPERMIT <br />J <br />_TOTAL <br />FEE S <br />TOTALPEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER 1 <br />FEE <br />USEZONE <br />LOTABEA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />— <br />TYPE OF CONST, <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />$ <br />SIZE OF SLOG. <br />NO OF STONES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE <br />,A J,. 0 / <br />TOTAL <br />RECEIPT N0. <br />FEE <br />