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TA. EFvp/Iw/1 '-`APPLICATION FIR <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNED ) MAIL ADORE.;S CITY ZIP PHONE <br />/L'� i/II E'er7(]I Ct/I�l NL1'1� f"�/ERE'%r <br />ARCIIIIECI OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GLNI RAL CONTRACTOR MAIL ADDRESS ' CRY ZIP PHONE LICENSE <br />I�.T-"(7.z Arc— I ��./! CEO. F, . i% l.ci L17%/Lr/UIWD 9PO4b 77C•'-Ti 77» /if/Cf(V Nk-2v/7Ll <br />CITY ZIr PHONE LICENSE <br />PLUMB('/GCONTnACTOR MAIL ADDRESS CITY ZIP PHONE <br />CI SS Or WOnK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK (� <br />usE oror Bun <br />CC'M M El= (? / /14_. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND 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 />SIGNAT E FCONTRACT/OR OR AUTH lZ*D AGCNT DATE �J <br />LEGAL DESCRIPTION Or PnOPESTYISHOWN BELOW OR ATT/GH FOUR COPIES) <br />Lu—_nLOCK—or <br />PROJECT ADDRESS <br />Ct/AL A/LC <br />APPLIL TSCITY BUSINESS LICENSE HO <br />PLUMBING <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHCWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <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 />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—PAINE. EAD'RS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR, ETC.I <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL 3 <br />----.—SUBTOTAL <br />PERMIT <br />TOTALFEE 3 <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />INDENT SETBA6K <br />RLAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />-- <br />_ <br />TYPL OE CONSI <br />OCCUPANCY GROUP <br />_ <br />NO, OF DWELLING UNITS <br />BUILDING <br />% <br />SIZE OF BLDG <br />NO Or STORIES <br />MAN OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />MECHANICAL <br />Oi11ER <br />PENALTY <br />APPHCATIONACC BY <br />PLANSCHECKEDBY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />1(�81RL(2 <br />