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TA. EY.ry,MR i,,'PFICATION FOh P <br />CITY OF CONSTRUCTION O <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ACOMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />—.1— MAIL ADDRESS CITY ZIP 1,1101I <br />S C(5, EgE7gE! 1-II32C <br />MECHANICAL CONTNAGN)R MALL ADDRESS CTY ZIP PHONE - tiff.;1 <br />°L{IMBINO CON IRA CIOR MAIL AOOBE50 CN• [u" ..•urv. .� Ins, <br />P < aft S+und %1 W•(ns;40 LodEr�TI iB1nY �Y3 9S3i PaG-rs !Y/ ra <br />:LASS CW WORM <br />UL NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />uLUA1ON or woRY ICOSI or MA IF HIM r, PL OS LARORI / <br />I'i Z ..nil <br />DFSCRIBE WORK 1 <br />.I _ . al- _. c r..LA c6.. r.{.L. / )R� , L <br />USE OF BUILDING � <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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />L[OAL p[SCBIPTION Ot pROPERM1ISIIOWN BELOW OR AT IACM FOUn copitsl <br />Ce+kbr <br />OF WORK WILL BE COMPLETED WITH WHET) IER SPECIFIED HERE- <br />LOI 3o BLOCK Of <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL 1HE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE or CONTRACTOR O" IHORIZEO AGENT DATE <br />X ba-. 4 TA ' A6 a1tk- _ <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE No <br />/09oI-- 31ct u <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE Or, ITEM <br />FEE <br />NO. <br />TYPE OF EOJIPMENT <br />FEE <br />7 <br />WATER CLOSET (TOILET) <br />A,C - A,HNDLG UNITS - 11 P <br />BATHTUB <br />REFRIGERATION UNITS - TIP EA. <br />Z <br />LAVATORY IWASH BASIN) <br />n <br />V0 <br />BOILERS -B.T UIHP <br />Z <br />SHOWER <br />GAS FIRED A C. UNITS -ETT.0 <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS - B T U M EA <br />DISHWASHER <br />WALL HEAT ERS - BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHED- <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />T <br />)U <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE 11001) <br />BACKFLOW PREVENTEDS <br />WATER HEATER <br />(d <br />[Ir <br />ROOF DRAINS - RAINLEADEDS <br />WOOD STOVE <br />_ <br />SINK ISERwCE - BAR. ETCI <br />METAL AMBP(IAOLLA CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />' <br />(AS PIPING <br />EXHAUSTFAN <br />_ <br />SUBTOTAL $ <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />_ <br />TOTALFEE f <br />L <br />1 <br />TOTALFEE <br />( <br />•I� <br />IUUr+i SE TRACK <br />PLAN CHECK NUMBER <br />FEE _ �y <br />RECEIPT NO <br />NGARSLIBACK <br />SIDESETBACK <br />D' <br />2c.' <br />If -1. _ <br />3 8 19 3 <br />Lc <br />USE ZONE <br />LOT AnEA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S,Lj; (j(;.0 <br />) <br />+'a Z.7 <br />L- <br />5G <br />- I <br />,175, 5 _ <br />(ES ONO <br />TYPE OF.�XIST <br />OCCUPANCY CROUP <br />NO OF pWFLLlN6 UNHS <br />PLUMBING <br />11 4 <br />OG <br />V -N <br />Yr-- <br />SIZE OF BI BO <br />No OF SIORIES <br />MAX OCC LOAD <br />MECHANICAL <br />S I I <br />Li C) <br />/l <br />OTHER <br />1� S <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED OYES eNO <br />STATE ENERGY SURCHARGE <br />AIIPLICAT104ACC BY <br />PLAITS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />LL_ <br />�A'•.i <br />I�7� <br />i�ILili <br />TOTAL <br />T �C <br />— <br />rnurcnl rvrrncr.�..r.�,..... •�.. _..___. _..__._. _... _ __ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />