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A:I�PLICATION 170k ' <br />the CITY Fpmn <br />Lltt OF <br />CONSTRUCTION <br />O <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION 0 COMBINATION ❑ BUILDING AMECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER MAIL ADDRESS Uln 11, 11. 1 <br />jReoeL",6 rnriNAEFsn 1gda t=uFeee\ fwu—Y- lEjrdz tr 98-.)o9 'ass- 5414 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRA=—. MAIL ADDRESS t�L CITY � ZIP�4 ��� LICENSE• <br />FQ1�t�1 T cQ <�T(a CC\OIJ \cros PuE ���N <br />MECHANICAL CONTRACTOR MAILADDRESS LT CITY ZIP PHONE L\CENSE• <br />Ml:_ \y MF-CL _', \MZA� 96 153e�. I F2__ fC) <br />PLUMBING CONTRACTOR MAIL ADURESS CITY ZIP P14011E LICENSE• <br />NEW V ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DLMOL111ON ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF W ORK ICOST OF SIAIET—E PLUS LABOR' <br />DESCRIBE WORK - \ <br />1_\ I,aA !r \ - CZ�A 1L11T.� k 'nLX.T4.7LY2Lr ( APP TY I�/...WL_ <br />USE OF BUILDING <br />I HEREBY CERTIFY 1*HAT I HAVE READ AND EXAMINED THIS AP• <br />2�-=:v C�.L, <br />PLICATIONAND KNOWTHESAME TOBETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPEN T Y(SHOWN DELOW OR ATTADI I F OUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BLOCK­ CF <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 1 HE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF GO R tO4OR D AGENT GATE <br />X <br />PROJECT ADDRESS <br />n�Q <br />APPLICANTS CITY BUSINESS LICENSE NO <br />i oa <br />-- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUWMEA, <br />WATER CLOSET (TOILET) <br />AIC — AIHNOLG UNITS — H. <br />BATHTUB <br />REFRIGERATION UNITS —H <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T. UJH P. <br />GAS FIRED ABC. UNITS — B.T <br />SHOWER <br />FORCED AIR SYSTEMS — B.OISHWASNER <br />KITCHEN SINK A DISP. <br />WALL HEATERS— B.T. UOISHWASNER WALL HEATERS—B.T.U.LAUNDRY <br />TRAY <br />UNIT HEATERS — B.T.U. <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />'WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 8 CHIMNEY <br />—' <br />FIREPLACE INSERT <br />H TPUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />$ <br />PERMIT <br />TOTALFEE S 70TALFEE <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />r ROhF SETBACK REAR SETBACK SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />S <br />OYES ONO <br />BUILDING <br />TYPE OF COAST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF CLOG <br />NO OF cTORIES <br />MAX. OCC LOAD <br />MECHANICAL <br />OC <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLA.NSCHECKCD BY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />YC <br />..�...,.....3E�..oDETEvululur_A'I <br />PROPER I Y UWN LHO hP¢ RE��..L�.....-�. �. �.......... <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />