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` "PPLICATION I'div <br />F°"'" <br />CITYOCONSTRUCTION <br />cln of <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8810 TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING (MECHANICAL <br />❑ PLUMBING <br />e7een <br />P' <br />❑ SIGN <br />GENERAL CONTRACTOR MAIL AGGRESS CITY ZIP PHONE LICENSE• <br />MECHANICAL CONTRACTOR MAIL AGGRESS CITY ZIP PHONE LICENSE• <br />e-L Dr, „Flr M1,11L i,w I/%.<f JS44411,r ALi 5rA 211,2S" '?�V36GB <br />CRY <br />CLASS OF WORK <br />9❑ NEW <br />ADDITION ❑ ALTERATION ❑ REPAIR El DEMOLITION ❑ WOODSTOVE/FRPL.INSERT El BUILDING RELOCATION- <br />WLUATION OF WORK'COST OF MATEflULS PLUS LABOR) <br />USE OI/tlWLVIHV . - v " I HEP'-BY CERTIFY •i HAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL OESCRIPTIONOF PROPERTY IS. MAN BELOW OR ATTACH FOURCOPIES) PNOVISIONSOFLAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORKkY!LL BE CDAIPLETFD WITH WHETHER SPFS,IFIED HERE <br />LOT— BLOCK ._OF IN OR NOT. THE GRANTING OF A PERNUT DOES NOT PRESUME TJ <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 -CONTRACTOR OR HORIZED AGENT DATE <br />X .23--L <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />TYPE 0' FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ; TOILET) <br />A/C — A/HNOLG UNITS — M.P. <br />REFRIGERATION UNITS — H.P, EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H.P. <br />I <br />GAS FIRED A.C. UNITS — B.T.U. <br />SHOWER <br />KITCHEN SINK Q OISP. <br />FORCED AIR SYSTEMS —BT.U. MEA. <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS — B.T.U. M <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER, HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR, ETC.) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP_ <br />7� <br />L.J <br />GAS PIPING <br />-- <br />EXHAUSTFAN <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT S <br />PERMIT <br />TOTAL FEE f <br />TOTALFEE <br />L PLAN CHECK NUMWip. <br />FEE <br />RECEIPT NO. <br />InONi SETBA, <br />O <br />REAR SETBACK <br />SIDE SElOACK <br />F <br />USEZONE <br />LOTAREA <br />SITE <br />FEES <br />VALUATION <br />FEE. _ <br />$ <br />ONO <br />_ <br />ENO.OF <br />BUILDING <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />WELLING UNITS <br />PLUMBING <br />__ <br />SIZE OF BLOC <br />NO. OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />n <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPLICATI�ONTACC BY <br />PLANS CHECNEEBY <br />APPR. FOR ISSUANCE BY <br />pUBLiC WORKS <br />TOTAL <br />PRUYCH I T V WIVCn.J I•nc nun v.�•��.-. _.. __. _. _. _.. <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />