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Ac PLICATION FOI` <br />CRY OF '" <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK •PLEASE PRINT <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />OWNER <br />MAIL ADDRESS Clly ZIP <br />� BM r�/,tI�AAir <br />!'Av_ cis ��rn/c <br />tJ S SPr"�Jr c��ul << <br />1350 0 Shot <br />/ CITY jlc <br />J <br />ARLNITECi OR OE4GNER <br />MAIL ADDac ss <br />1 <br />GENERAL CGNIRAGIOR <br />GE <br />Zip <br />•MHlADDRESS <br />/1 Ate. <br />everen <br />e <br />❑ PLUMBING ❑ SIGN <br />PIwvE7i,N GrO^ImAlQa, <br />//--Y// <br />MAq ADORE55 ONY •.•• •.•,-• --- iE <br />PLUMPING CONTRALTOa L l <br />CLASS OF WORK <br />IIG NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />y VALUATION OFtWORK IMA1ERIAL51Ll / i l _ — <br />N <br />OE SCRIBE WORK / 11 <br />' � CI •Ai C % � � G P C' <br />,I <br />{ <br />l <br />( <br />I <br />1 <br />A <br />PHONE <br />. <br />D( <br />us <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF PROPERTYISHOWN REIOW OR All RFOUR COPIF. SI <br />LEGAL DESCRIPTION <br />f171 <br />C <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />�2 U llr ` C�i_ <br />�`UE7 <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT_�eLoc�Or <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 OFCONIPACTOROR AUTHORIZED AGENT DATE <br />p� <br />X <br />APPLICANTS CITY BUSINESS UCE NO <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />AIC — AIHNDLG UNITS — H.P <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS — H P EA . <br />BATHTUB <br />BOILERS — S T U IH P <br />WA <br />LAVATORY (WASH BASINI <br />OAS FIRED AC UNITS —B T. U. <br />SHOWER <br />FORCED AIR SYSTEMS —BTU M EA. <br />KITCHEN SINK & DISP. <br />M <br />WALL HEATERS -B T.U. <br />DISHWASHER <br />EATERS — B.T U M <br />LAUNDRY TRAY <br />RATIVE COOLERS <br />CLOTHES WASHER <br />ESDRYERS <br />URINAL <br />ATION FAN <br />DRINKING FOUNTAIN <br />HOOD <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />HEATER <br />ROOF DRAINS — RAINLEADERS <br />STOVE <br />FIREPLACE A CHIMNEY <br />SINK (SERVICE — BAR. ETC) <br />ROTALFEE <br />ACE INSERT <br />PUMP <br />IPING <br />STFAN <br />SUBTOTAL <br />fSUBTOTAL <br />PERMIT <br />fPERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />PLAN CH CK NUMBER FEE RECEIPT NO. <br />FRO_NT SEIOACK <br />REAR SETBACK <br />SIDE SETBACK <br />ISSGO�� <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S /O 7SZ- - <br />l <br />13�J <br />'TTES ONO <br />/ <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />�. Z <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDO <br />NO OF STORrtS <br />MAX OCC LO D <br />rz 3 <br />i <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES O <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />_ <br />TOTAL <br />con Mel RI c MR RFTFRMINING ALL <br />Cr c 1 a Z"3 i U on LsG l� i'IryU ROPERTY LINE LOCIO ATNS AND RELATED EASEMENTS, <br />Fcvc O" BAN <2e Fee— <br />