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Uu Everpr»n <br />APPLICATION FOR-J <br />evereR <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBIN,ATTII�OONt.`❑BUILDING MECHANICAL <br />❑.PLU!ABBII/NNG ❑ SIGN <br />.OWN <br />SI� <br />ADDRESS <br />4 <br />PIION��i� <br />` <br />w,fl,l //Tl F <br />�/y(� <br />H/w. <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />&eio <br />/ZU12 /lo f.�.�9g�5 <br />i1Yxr� <br />GENERAL LON UCipR <br />MAIL ADDRESS / 'ITV ZIP <br />PHONE LICENSE• <br />A7.oiY7�/l7t //�JG <br />�f <br />'MM EECHCCHHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE 9 UCEN <br />_ <br />55 <br />CLASS OF WORK <br />T� 14 <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODS, OVE/FRPLINSERT ❑ BUILDING REI OCAIION <br />VAX TION OF WORK (COST OF MATERIALS PLUS LARORI <br />40 <br />USE OF IUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAME TOBETRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND 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 OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE F CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPL N SCITYB INESS LICENSE NO <br />I GAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT__BLOCK—OF <br />PROJECT ADDRESS <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 ITOILETT <br />A/C—A/HNOLG UNITS — HP. <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B. T.0 iH P <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK A DISP, <br />FORCED AIR SYSTEMS — B T IJ. M EA. <br />DISHWASHER <br />WALL HEATERS —BITU. M <br />LAUNDRYTRAY <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 />_ <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INS.HT <br />_ <br />HEATPUMP <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUBTOTAL T <br />SUBTOTAL <br />PERMIT $ <br />PERMIT <br />TOTALFEE <br />5 <br />TOTALFEE <br />RECEIPT NO. <br />PLAN CHECK NUMBER <br />FEE <br />FRONT SETBACK <br />REAR SETBACK <br />SiOL SETBACK <br />USEZONE <br />LOTAREA <br />UYES <br />UYES ONO <br />O <br />FEES <br />VALUATION <br />FEE _ <br />BUILDING <br />S <br />NNE OF CONSi <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />_ <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAY OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />AIJPLICAHONACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />_ <br />PROPEH I Y UVYNtHJ Nn[ nwrvnolocc 11" --I ........, ..... <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />