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K <br />the EwrpFe�n �OAPPLICATION Fdk Uvrren <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 />OWNER MAILADDRESSClttZIP <br />11 PHONE .la t..r� C � �RZo( H-?— L` <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />City <br />ZIP <br />PHONE <br />LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />IALUAL�ON�(OF WORK (COST OF MATE RMLS PLUS LABOR, / <br />T` 1A1 4-G his �./�C'-l/ - �1 �O�a� 5.3r�.L <br />CA, (LG_(5 314 LU La 0 <br />G <br />)ESCRIBE WORK <br />-�2 II r <br />` USE OF BUILDING <br />/ <br />t-k Car5 LA.6t -T <br />I HERE15'i CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISI ONS OF LAWS AN D O RD I NANCES GOVE RN I N G T H IS TY PE <br />OF WOR K WI LL BE COM PLETED WIT H WH ETH ER SPECI FIEDHERE- <br />IN OR NOT. TH_ GRANTING OF A PERMIT DOES NOT PRIES UME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER ST:QE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR Oil AUII/ORIZED AGENT DATE <br />//�11 Ao Q�nJ X [f / /L 1 (D s <br />LEGAL DE>c IPPON OF PROPERTY ISH OWN BELOW OR ATTACH FOUR COPIES. <br />0Iiii-31� 13 Fnd�YS Ls-t AA-r, �LLe, ' <br />L At r— <br />PROJECT ADDRESS <br />3G0r. _LA_c(*r vere7` W,. )S_Z0( <br />APTCIILAIITS CIi 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 />_ <br />REFRIGERATION UNITS-H. P. EA, <br />LAVATORY (WASH BASIN) <br />BOILERS-11.P EA <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />_WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS -Di. U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK (SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />I <br />SUBTOTAL <br />_ <br />SUBTOTAL S <br />PERMIT S <br />PERMIT __ S <br />TOTAL FEE $ <br />- TOTAL FEE- S <br />THIS PORTION i O BE COMPLETED <br />BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK / <br />lJ 0 <br />SIDE SETBACK <br />/ Z <br />PLANCHE K NUMBER <br />PLAN <br />FEE Yf <br />WIECKFEE <br />AEC[ T NsFII� <br />USE ZONE <br />(Z -y <br />LOT AREA <br />L �) <br />VACANT\•SI;e <br />OYES / <br />FEES <br />VALUATION <br />FEE <br />TYPE Of COHI5A1 j <br />U� <br />OCCUPANCY GROUP <br />111 ' I <br />NO. OF DWELLING UNITS <br />I <br />BUILDING <br />S/ <br />SIZE OF BLDG y <br />1 I i`r) LIJ <br />�T 1 <br />NO. OF STORIES <br />I <br />MAX. OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED ❑ YEE O NO <br />OTHER <br />PENALTY <br />_ <br />APPLICATIOIIACC. BY PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />----- <br />TOTAL <br />/N., r;(J r)C4A..� .F.IL• �L.V,.� r� - Jl,.T s..,.F.�+ <br />7 �U Ocic> D,C1 �Tc/JL' CiJL--ZC. <br />7 r� <br />O <br />m <br />u <br />