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APPLICATION FQQ <br />' C4rVOf " CONSTRUCTION <br />GTY Of <br />everett PERMIT <br />i BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION 46 BUILDING ❑ MECHANICAL <br />OWNER , ♦ ^ , MAIL UUR195�I � CIry Q � l�I,P�/ <br />I <br />• ARCRITECT0R DESIGNER MAIL AUDPCSS f.ITY nv <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />PnonE <br />LICENSE <br />�elloalc� a9i� Ste_ <br />Sd� E uJif <br />9��oi <br />ass <br />�6111,A 04V <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE IF <br />❑ NEW ❑ ADDITION ❑ ALTERATION A REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF W:� C904oIALS PLUS LABORI <br />sv�Y )lO,f3E i l / /in %i�it �O I'.1 Oif r <br />USE OF BUILDING U_ <br />'-��L^�"' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUE ANDCORRECT.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 />SIGNATURE OE NTRACTOR OR AUTHORIZED AGENT DATE <br />X / 0 �(c <br />L AL DEBLRViION OE PgOPERTY I9HOWH BELOW RAiIACH FOUR COPIE91 <br />LOT_BLOCKOF <br />PROJECT ADUREBS <br />APPLICINt9 CITY BU E 95 LICENSE NO <br />PLUIMBIMO <br />MECHANICAL <br />M0. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />_ <br />AIR CONE) UNITS—H. P. EA. <br />BATHTUB <br />_ <br />REFRIGERATION P. EA. <br />LAVATORY WASH BASINJ <br />_UNITS—H. <br />BOILERS—H P. EA <br />SHOWER <br />_ <br />GAS FIRED A(,. UNITS —TONNAGE EA <br />KITCHEN SINK B DISP. <br />_ <br />FORCED AIR SYa TEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES Of I-RS <br />_ <br />URINAL <br />VENTILATIO. j AN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />DRAINS—RAINLcADERS <br />METAL FIREPLACE& CHIMNEY_ <br />_ROOF <br />SINK SERVICE —BAH ITC. <br />WOODSTOVE/FIREPL/CE INSERT <br />EUS TOTAL <br />SUB TOTAL f <br />PERMIT B <br />'ERMIT B <br />'.OTALFEE B <br />_ <br />TOTAL FEE B <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAIISETBACK SIDE SETBACK PLA"CHIC R NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />101 AREA VACANT SITE -- — <br />DYES ONO FEE& VALUATION FEE <br />MAX OCC LOAD <br />BY IPLANS CHECKED BY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />07HER <br />PENALTY <br />TOTAL <br />9 <br />