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EA. EY.FPEf.I 'APPLICATION FO0 rLftfll <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT <br />259-8745 <br />❑ COMBINATION <br />❑ <br />BUILDING <br />❑ <br />MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />.I <br />PHONE <br />-T <br />7/ <br />(MAIL <br />«' <br />i•11CCLi ))/' <br />6-1 <br />� ' r C <br />S'Gti:/- <br />pESIGNER <br />ADA <br />TY <br />PHONEAR <br />:t7-ttJ1( rierr <br />�1 cl <br />G�.7iy2iOIRE <br />_ <br />GENERAL CONiRALTUR <br />LORCSS? <br />AD <br />LIIY <br />TIP <br />LICENSE Ac <br />33 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE IICENSFY <br />CLASS O! IIORKI, — <br />❑ NEW Er ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VA, UATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />"3 C' I"L'c <br />DESCRIBE WORK <br />USE OF BUILDING <br />�,);c_ ; I-)e r`L <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PL ICA T ION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS A NO ORDINANCES GOVERNING T HIS TYPE <br />OF WORK WILL BE COMPLETE DWITHWHETHER SPECIFIEDHERE- <br />IN OR NOT, THE GRAN TING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY 10 VIOLAIE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNA TUN). OF CON I FACTOR OR AUTHORIZED AGEN I DAZE <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW ORATTACH FOURCOPIESI <br />LOT BLOCK 1) OF UbZIJ IAl'k-%' D•TLI <br />cot 1. <br />Y <br />LLI I �L.'G I 1�L. L IICLIF TF� ice_ <br />PROJECT ADDRESS <br />AFPLICANFSCFY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS—H P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-14P EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK f 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 />_ .. <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS _ <br />_ - <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM SPEAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADLIS <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK SERVICE —BAR, ETC. <br />_ <br />WOODSTOVFIFIREPLACE INSERT _ <br />SUB TOTAL <br />_SUB TOTAL f <br />_ <br />PERMIT f <br />PERMIT s <br />_ <br />TOTALFEE f <br />_ _ TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />74ONTSETBACK <br />GEAR SETBACK <br />SIDE SETBACK <br />PLAN CHEEK NIL <br />F�-' -//y <br />_ <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />TYPE OF CONST. <br />v-1-1 <br />OCCUPANCY GROUP <br />` J <br />NO. OF DWELLING UNITS <br />I <br />BUILDING <br />SIZE OF BLDG <br />14 'L 5• F• <br />NO OF STORIES <br />I <br />MAk OCC LOAD <br />NA <br />-- <br />PLUMBING <br />� <br />FIRE SPRINKLERS REQUIRED ❑ YES CR'NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />7y <br />APPF FOR ISSUANCE BY <br />TOTAL <br />FEE RECEIP NO <br />FEES VALUATION FEE <br />f <br />