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IM EmMommoR <br />CITY DF <br />everett <br />PPLICATION FOw <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �d PLUMBING ❑ SIGN <br />GWNER MAIL ADDRESS [ CITY ZIP PHONE <br />L'I <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR - MMUDDRESS ^^ CITY ZIP PHONE LICENSE• <br />4-1-PR �kni' 1Yh�pof=N+ �///- nr ;'f Fvrreti' - r�/ .31�7 ?27K .srAl? 177 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CITY <br />'jam NEWM^❑ ADDITION ❑ ALTERATION v(REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />USE OF WILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X lk <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPES) <br />LOT_BLOCK _oF <br />PROJECT ADDRESS ,Z <br />y.2 -7- <br />APPLICANTS CITY R INES9 LICENSE NO. <br />►LUMSING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT _ <br />FEE <br />WATER CLOSET (TOILE <br />DO <br />__ <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY WASH BASIN) <br />O <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />_ <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHE <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />20 <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F, M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAMLEADERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK SERVICE -BAR. ETC.I <br />WOODSTOVE/FIREPLACE INSERT <br />0 U <br />SUB TOTAL <br />O 0 <br />SUB TOTAL { <br />PERMIT { <br />D 0 <br />PERMIT t <br />TOTALFEE { <br />TOTALFEE t <br />FRONT SETBACK <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />USE ZONE LUI AHLA VACANT SITE <br />T CITES ONO <br />TYPE OF CONST, OCCUPANCY GROUP NO. OF DWELLING UNITS <br />NO. OF STORIES I MAX OCC. <br />BY PLAITS CHECKER BY I APPR FOB I SSUANC EBY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALLY <br />TOTAL <br />FEE I RECEIPT NO. <br />FEES I VALUATION I FEE <br />3 <br />