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�PLICATION FOk „j <br />c e E"rg m <br />CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADOR1 cITY 0', PHONE <br />/33z lr7l L (led(, 11 7S- 74� -2-4/2— <br />ARCHITECT OP OL5IGN:H • raAIL ADDRESS CITY 211, PHONE <br />GENERAL CONIRACIOR MAIL ApOgEiS CITY TIP PHONI LICENSE <br />MAIL ADDRESS C i ZIP PHONE LICENSE <br />MECNANIGLLONiPAL1Cq <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY LIP PHONE LICENSE <br />:LASS OF FORK <br />rl NRw ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT _ ❑ BUILDING RELOCATION <br />/ A C. __z 1, -, <br />usE OF BuuoING <br />I HEREBI CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />/ <br />PLICATION AND KNOW THE SAMETO DETRUE AND CORRECT. ALL <br />PROVISIONS OF LP "VS AND ORDINANCES GOVERNING THIS TYPE <br />LEnu DscnlPnDN or Pgorrnir is wN Buow on ATteai roun Lowest <br />ppp1��Fl 7„D <br />OIT WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />OR NOT. THEGRANTINGOFA PERMIT DOES NOT PRESUME TO <br />LOT BLOCK-Oc <br />IN <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 C FACTOR AUTHORIZED AGENT DATE <br />PROJECT AT)RE`.5 J,[ <br />APPLIC NiSC ITY BUSINES ,ENSE NO <br />� <br />PLUMBINGMECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC - AIHNOLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B.T U,H P. <br />SHOWER <br />GAS FIRED A C. UNITS -8. T. U. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS - B T U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />'NIT 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 BERVICF. - BAR. ETC I <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />It <br />PERMIT <br />3 <br />PERMIT <br />_ <br />TOTAL FEE <br />It <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />l <br />SIDE SEIOALK <br />C/ <br />FRUNi SETBACK <br />I <br />1 <br />20 <br />70 <br />a <br />USEZONE <br />LOTAREA <br />VACAl TSITE <br />FEES <br />VALUATION <br />FEE <br />S <br />�0Sr <br />D 2 <br />OGO 76,oYEs <br />UK6 <br />BUILDING <br />OLL <br />TYPE CFCF CO i <br />OCCUPAN YGQROUP <br />NO.OFDWELLING UNRS <br />-� <br />- d <br />/ <br />PLUMBING <br />SIZE Or SLOG /'! <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />7mD Sr <br />v,4' <br />OTHER <br />STATE BUILDING SURCHARGES <br />Cj <br />lJ <br />FIRE SPRINKLERS REQUIRED D YES pA NO <br />STATE ENERGY SURCHARGE <br />APPLICA71ONN BY <br />PLA115 CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />�IAC.C,T <br />J/1/1/I/\ <br />YHUYtH I T LH YN... Hnc n�.,. v.... ..-.. —_. _........._ _ ..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />