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c 1 �" <br />RMEY.FPJMFI �► P P L I C A T I O N F O'D BYBF�„ <br />CinCONSTRUCTION e <br />;{ everett PERMIT <br />y BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK• PLEASE PRINT <br />r <br />i ❑ DEMOLITION JX COMBINATION W BUILDING O MECHf %ICAL PLUMBING ❑ SIGN <br />MAIL <br />A <br />CLASS OF WORM / <br />t ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ <br />VALUATION OF WORK ICOST OF MAFE RI ALS PLOS LABOnI 1 <br />� P r�irr a�u, 7i, nT <br />i DESCRIBE WO K <br />J <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />CRY <br />«tZCc <br />21P <br />94� 2 s' <br />PHONE <br />3G y78mo Aga <br />LICENSE <br />t�/ / <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />_MOLITIGN ❑ <br />WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />\\ <br />�CCL� ('Y`'�Y �IF1a)(f- Cln�l <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY SHOWN :LOW ORA ACH Foull PIESI <br />OF WORK WILL BECOMPLGTED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK- OF <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 />�I <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE J IS187 <br />X / <br />PROJECT ADDRESS <br />APPIL 41T♦BUSI-NF�-SSLICENSENG <br />- C .lrl .'Idr_-.F <br />c . , <br />y:ZI <br />PLUMBING U <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET JTOILED <br />AIR COND. UNITS-11. P. EA. <br />_ <br />/ <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />jr <br />LAVATORY JWASH BASIN) <br />BOILERS-H.P. LA. <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />RANGE. HOOD <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- FAINL EADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTALFEE f <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />510E SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCYGROUP <br />NO, OF DWELLING UNdJ <br />BUILDING <br />S <br />,T <br />SIZE OF BLDG <br />NO. OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />70 <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES Cl NO <br />OTHER <br />1 <br />PENALTY <br />_ <br />APPLICATION ACC BY PLANS CHECKED BY <br />APPR FORISSUANCE BY <br />TOTAL <br />� <br />o <br />