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=APPLICATION FO: <br />IT,E,,,,F„R <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT 161 <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />\ <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL `p PLUMBING ❑ SIGN <br />OWI - <br />9 <br />MAIL ADDRESS CITY ZIP PHONE <br />��/d S� <br />e NG �J(LL1Ly1[' <br />FIIiFGtrNiacc (gAE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />MECHANICAL CONTRACTOR <br />MALLADDRESS CITY ZIP PHONE LICENSE <br />PLUMB NGOONTRACTOR <br />Suo�tl�uca wA>,IcAl_W <br />MAIL ADDRESS CITY ZIP PHONE LNSEA <br />ICE <br />II��5 t' AA N-1, '1 in�,L)A9P,Iz <br />CLASS OF WORK <br />3l�`►-3 S rTl o <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF ViO.RK(COST OF MAT E R IAL5 PLUS <br />LABOR) <br />301070. po <br />DESCRIr1p[, WORK <br />% . t-., <br />P04, /, ,a_I.P. <br />USE O(FD BUILDING <br />V- <br />I HEREBY <br />h�-�A� ` <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR -COPIES) <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISIYPE <br />LOT— BLOCK_ O <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 Off <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESS <br />APPLICANTS CITY JU ESS LICENSE NO <br />PLUMBING _ <br />MECHANICAL <br />NO.j <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />O <br />CLOSET(ToILET) <br />AIR COND. UNITS-H.P, EA. <br />UB <br />REFRIGERATION UNITS-H.P. EA. <br />RY(WASH BASIN)BOILERS-H.P. <br />EA. <br />R <br />GAS FIRED AC. UNITS -TONNAGE EAN <br />SINK 8 DISP.FORCED <br />AIRSYSTEMS-B.T.U. MEA. <br />ASHER <br />WALL HEATERS-B.T.U. M <br />- <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />+� <br />WATER HEATER _ <br />CLOTHES DRYERS <br />URINAL <br />7_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />IQ <br />DO <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANOLING UNIT- C.F.11. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAMLEADERS <br />O <br />METAL FIREPLACE& CHIMNEY <br />_ <br />SINK SERVICE -BAP, ETC.)WOODSTOVE/FIREPLACE <br />INSERT <br />¢ <br />Z <br />SUBTOTAL <br />SUB TOTAL S <br />56 <br />PERMIT S <br />_ <br />PERMIT $ <br />TOTAL FEE _ $ <br />TOTAL FEE 5 <br />�R- <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLANCHEeFEE <br />—�- <br />FEE RECEIPT NO. <br />USE ZONE <br />LOt AREA <br />VACANT 511E <br />FEES <br />VALUATION <br />FEE <br />❑YES ONO <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />SIZE <br />APPLICATION A1�CCC. <br />m <br />PLANS CHECKED BY <br />MAX. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S <br />