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' JPPLICATION FObe, <br />the EVI/°'"° <br />CITY <br />CITY <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION <br />❑ BUILDING O MECHANICAL <br />nwucn <br />_MAILADDRESS ..- ��L CITY ZIP, <br />OR <br />everett <br />e <br />❑ PLUMBING ❑ SIGN <br />GE14 H LCONJRAOrOR <br />/ MAIL ADDRESS <br />I CITY <br />/ ZIP_ <br />PHONE <br />LICENSE <br />,Ecru how �O <br />�-oi�4f <br />�91, <br />IAELHANIGLCO111f1ACiOR <br />MAIL ADDRESS <br />CIrY <br />UY <br />PIIONE <br />ICEfISE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />A ALTERATION ❑ <br />REPAIR ❑ DEMOLITION ❑ <br />WOODSTOVE/FRFLANSERT <br />❑ <br />BUILDING RELOCATION <br />VALUATION OF WORK ICOST OV- E DIALS PLUS LABOR, <br />oesL(R71/A/1RK <br />Ti <br />I <br />USIE OF BUILDING <br />/ � <br />�— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHESAMETOBETRUE 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 OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />APPI JT. GRY pUS)NESGIICErvSE NO <br />L ALD IPNDrJ PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCKF <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 ITOILETI <br />A/C - A/HNDLG UNITS - H.P. <br />BATHTUB <br />REFRIGERATION UNITS -H P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS - B.T U H P. <br />SHOWER <br />GAS FIRED A.C. UNITS - 33 U. <br />KITCHEN SINK d DISP. <br />FORCED AIR SYSTEMS - B.T.U. M EA. <br />DISHWASHER <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 />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.) <br />METAL FIREPLACE 5 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />s <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEF. <br />S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />PEE �O, <br />RECEIPT NO. <br />I RONr SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VAC AN,v1E <br />OYES nO <br />FEES <br />VALUATION <br />FEE _ <br />BUILDING <br />S <br />J <br />3s'� <br />�ssc <br />TYPE OF CONSi <br />22 N _<?9NfC <br />OCCUPANCY GROUP <br />n <br />!J"2 <br />NO. OF OIYF LLtNG UNITS <br />d�_ <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAK. OCC LOAD <br />MECHANICAL <br />""���� <br />FIRE SPRINKLERS REQUIRED yTYES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />rJ' <br />STATE ENERGY SURCHARGE <br />APPUCALON ACC BY `1/ " <br />PLANS CHECKED BY <br />APPH. FOR ISSUANCE BY <br />LG, <br />PUBLICWORKS <br />TOTAL <br />V <br />- <br />PROPERTY OWNERS ARE IONS AND <br />RELATED <br />T FDE ULIEHEASEMENTS. <br />ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />C 1.0A l <br />