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t-.PPLICATION FO►. <br />citlOF "° CONSTRUCTION <br />rm or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />Cl DEMOLITION ❑ COMBINATION 0 BUILDING ;).MECHANICAL IT PLUMBING ❑ SIGN <br />In' , Zip �nONI f <br />nwnl II � MAN.An " � <br />OI NERAL CONIRAC1O11 <br />�T., )c��� /�/ r-,i <br />AIAN AODBI 55 <br />' L /(�-/ .ti '1"�:; / <br />CIIV <br />� �� /'/ l � P•/!. <br />tll' rNIONI. ( J-i71C{ n <br />, <br />/�h J/ ��i'I/Fj. )E /(X /,`i' K- L�., <br />CUANICAI CnFORACIOIj <br />MAn ADIlll15S <br />COV <br />ZIP <br />NIONI <br />IRANS1 . <br />MAII ABIINf 55 <br />(TiY <br />ZIP <br />PIIPra <br />IICLWA . <br />PI IIMRNIN CONTA.0 Ion <br />cL A55 of WOn. <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSIOVEIFRPL.INSERT ❑ BUILDING RELOCATION <br />VAIUATIONOTAor ,COSTOl KOIEnIAISPIUSIABORI <br />nrSCR,BuaIRR <br />/•l�Ki/i�/ 1. 1: `-A 11 'f 1L .: I�F f�.�( hJ.`1 <br />usr or aui1nnlcJ / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />/�{�� / <br />PLICATIO!JAND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONSOF I- AWS AND ORDINANCLSGOVERNING T HIS TYPE <br />LEGAL DESCRIPTION Or PROPERTY,SHOWN R[I OW ORAITACIIrc,uA COPI[51 <br />OF WORK WI11 9L COMPLETED WITH WHETHER SPECIFIED HERE- <br />LoI—BLOC�OF <br />IN OR NOT. IHE GRANTING OF A PCFAMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />-- <br />ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />bIUNA)UHLU1 I.JNIRAIGIUIIUHAI:IIIORIZLOAGLNI DATE <br />PROJECT ADDRESS 1 <br />APPL 11:AN7CI1Y BnGINESX Ii rl NSF 'it) <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILET) <br />A,C - A,HNOL.G IINITS - HP <br />BATHTUB <br />REFRIGERATION IINITS - H P EA <br />LAVATORY (WASH BASINI <br />301LEFIS -- B I I),H V <br />SHOWER <br />GAS FIRED AC LINTS -BT0 <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS - B T U M EA <br />DISHWASHER --- <br />—__ --- <br />- <br />WALLHEATEIIS--BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T LI M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CI 0114ES DRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTH ATION FAN -_ <br />FLOOR DRAIN <br />RANGE 11000 <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC 1 <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />ENHAIIST FAN <br />SUB TOTAL <br />f <br />SUB TOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTALFEE <br />S <br />TOTAL FEE <br />- <br />I q An CULA;K NUMUEII <br />FEE <br />RECEIPT NO <br />REAl15k'BAf,K <br />SIDE SLInAf.H <br />I NUN) SE IBAC.R <br />USE ZONE <br />tot AREA <br />VAI..NT S,IL <br />FEES <br />VALUATION <br />FEE <br />S <br />Ill LS IINO <br />D1111.U1NG <br />-_ <br />TYPE Of f.ON51 <br />OCCUPANCY GROUP <br />NO Or owlI WG UNITS <br />PLUMBING <br />SIZE OF BI DG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPI,CAIION ACC BY <br />PI. ANSCHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />cwnumwl F FOR nFTFRMINING ALL <br />_ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />