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fftE.FFpNwn <br />..PPLICATION F061 <br />CITY OF <br />CONS <br />everett <br />RM TTIONP <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION 0 BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OW�N.Eq/ T <br />,41P.y4/4//r�5c.✓ <br />MAIL ADDRESS iY ZIP <br />/7� slliG/lr.Tf'��f� <br />PHONE <br />Ija <br />RC TEC OR DE 04ER <br />nave <br />MAIL ApDRC55 CITY ZIP <br />PHONE <br />Rµ COHI FACTOR i� MAIL ADDRESS CITY ZIP <br />4? <br />�/ eta ef���cp i>cracvS� W�'F.�� �l��c� <br />PHO <br />H <br />LICENSE • <br />MECHANICAL CON ACTOR <br />MAIL ADORES$ <br />a_x�,n9AG)?aeu <br />!� <br />/� <br />CITY jIP <br />PHONE <br />LICENSE <br />A <br />'LUMPING OMIN/iFACTOR <br />�/ l <br />MAIL ADDRE5S CITY ZIP <br />PRUNE <br />LICENSE. <br />LASS OF WORK <br />El NEW ❑ ADDITION ❑ <br />t�l <br />ALTERATION /"f REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />AL UATION(fWJORK IICCOS/TT OFF MATERIALS PLUS LABOR) <br />ESCCNIIBBE�W�ORK -/ <br />L <br />SE Oi BUILDING <br />P <br />I HEREBY CERTIFY THAT I HAVE READ <br />AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />EGALDESCRIPTION OFPROPERTYISHOWN BELOW OR ATTACH FOUR COPIE51 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />�T_BLOC% _OF <br />OFWORKWILL 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 />SIGNA TUU/, FF CC NTRACT09 AUTHORIZE GENT DATE <br />`Curt ^/mL /e — <br />YOJECT ADDRESS I'7 <br />A LICANTSCI BUSINESS NSENO <br />LUW@ING' <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />BATHTUB <br />IREFRIGERATION <br />UNITS-H.P. EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALLHEATERS-B T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B. T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR RAIN D <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE $1 <br />1 <br />fillTOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'IT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />TEE <br />CHECK FEE <br />RECEIPT NO <br />EOMF <br />LOT AREA <br />MEANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />OFCONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />OF SLOG, <br />NO OF STORIES <br />MAX OCC. LOAD <br />AnDv' W Y I PUNS <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />IPPR FOR ISSUANCL BY <br />TOTAL <br />