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/ pPLICATION FOB.—' <br />evereH <br />F°'"D curYO <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION ❑ BUILDING 0�4ECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OW, <br />CSC - I IJc <br />MAIL ADDRESS CITY ZIP <br />I �(OZ S F vefet' /1�,�(c 8 `� <br />PHONE <br />3Ss-s-`+`y�% <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICENSE• <br />MECHANICAL CONTRACTOR <br />11c 2t� I14CC(= <br />MAIL AODRE55 CITY ZIP <br />%6� l 3rRAL IJ I-- et—pmcILal7 %BUZZ <br />PHONE LICENSE <br />,3 92�S�I1nER�Tmz/63C�►1 <br />PLUMBING CONTRAC TOR <br />MAIL ADDRESS CITY ZIP <br />NICHE I LICENSE• <br />C AS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OP WORN ICOSi OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK _\ ` I <br />T � . �o ! 1 1 A IYL- Tip" 0 L A IL iT 1A AAA C--k <br />USE F BDILDING // <br />11..— <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 />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A F ERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY(5HOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK -_OF- <br />PROJECT ADDRESS n <br />APPLICANTS CITY BUSINESS LICENSE NO <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 (TOILET) <br />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS —B.T.U.,H. P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B.T.U. <br />KITCHEN SINK d DISP. <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASIIER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <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 />BACK FLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL <br />3_ <br />PERMIT S <br />PERMIT <br />S <br />TOTALFEE S <br />TOTAL FEE <br />S <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />IRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX DEC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />SPATE ENERGY SURCHARGE <br />APPLICATIONACC BY <br />PLANSCHECKEDBY <br />APPR. FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PRUHtHIYUWNENo AFENEaFGi.moLE -nvc u...............�.- <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />