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?PLICATION f�O LAC N57�'ON C7 <br />theE""°"'" CONSTRUCTION eYe[eR <br />c <br />CITY OR <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />C DEMOLITION U U,OMBINATION Cff6UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS C1tY ZIP PHONE <br />(,UILUfW\ 39C) :3mIrr\ Fvr--r F rr C✓n 9RZa3 11�� <br />ARCH-rECI OR DESIGNER MAIL ADDRESS CIrY ZIP PHONE <br />GENE FAIL CONTRACTOR MAIL ADDRESS CC rY ZIP FyY 9S PHONE 79'1SS� LICENSE <br />7"1.•../ c /nnNTro.. <�T=/ T'rI II L1]In/!-S h\Y. ui I FCAIA (�,ILT SO, TP/i L..,,. Oon 4.A-99037 <br />MECHANICAL CUNTHADH)H '^^'•^""^'-"' '""'" - -' <br />TF-r_MA 793-2 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />LW- NEWv^ ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL17ION Cl WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORKISOpT �Or AIERIALS PLUS LABCRI 22,00v �� <br />DESCRIBE WORK, <br />�...,<mlvr 1. , API-- Iir,11<.P fUJO 6F-r1, I IllI I7_J) Iv Cr <br />u5F of BmLDINc <br />S770CA F At-)_O UI=1—ICr <br />I HEREBY CERTIFY THAT I HAVE. READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUEANDCORRECT. 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 />LEGAL DESCRIPTIONOF PROPERTYISHOWN BELOW OR AT TAU" F OUR CUPIESI <br />LOT�BLOCIt_OF <br />PROJECT ADDRESS <br />APPLICANT'S 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/HNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — HP EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B. T.0 /H P <br />SHOWER <br />GAS FIRED A . UNITS — GT.U. <br />KITCHEN SINK S 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 />EVAFORATIVE 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 ISERVICE — BAR. ETC) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />IRONT sF.TDnc. <br />PLAN CHE K NUMBER <br />8� <br />FEE <br />RECEIPT NO. <br />AFAR SE rescK <br />SIDE s[TeAcn <br />USE ZONE <br />— / <br />LOT AREA <br />VACANT SITE <br />S ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/ <br />N <br />TYPE �OOr CON51 <br />,. <br />f-/V <br />OCCUPANCY GROUP <br />-z— <br />OOF DWELLING UNITS <br />4p— <br />PLUMBING <br />SIZE OF BLDG <br />�F.. �. <br />NO or S1oR1E5 <br />/ tiLs�,•�_ <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED U YES kio <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAIION ACC BY <br />PLANSC14ECKED BY <br />APPR FOR ISSUANCE BY <br />•'f;� <br />PUBLIC WORKS <br />TOTAL <br />c%{IL .E <br />t A <br />PRUPF.H 1 T UIVNtHJ AHt MtDrLA W OILJLU F V H vt I �n mllolvo •.AN <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />