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EvI {BBn ..,PPLICATION FO._Onof <br />lYETEN <br />everett CONPE Mi TION <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING O MECHANICAL Cl PLUMBING SIGN <br />DWNER r,N}a MAILADDRESS CITY ZIP PHONE <br />C CG4 h _ Il /l ul C[A» 1%�JI %U%/Yf R l!f RF'T Qd Jc J 77'f 41 i <br />UICHITECTORDESIaNER MAIL ADDRESS <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />/� (./i !y tc•,v S, oi, <br />i iwc-M-r <br />3 <br />l�i.IV i <br />3?3 �J'rf J' /QCFiI'kSl /aY RT <br />MECHANICAL CONTRACTOR <br />MAI ADpRlSS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />�Ac Link <br />PLUMBING CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PIIDNE UCSNSEA <br />LAE NEW RK❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />USE Of BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP - <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALLON <br />PROVISIONSOF LAWSAND 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 OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OFCONTRACTOR OR AUTHORIZED AGENT DATE <br />X C 7 <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES( <br />Lor_ BLocK_ of <br />PROTECT ADDRESS [� <br />�1f4312 ►Cuc_�c�l^ C��eP✓ w <br />APPLIC T CITY USI ESLICENlf NO <br />,6;-75f <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. UNIi3—H.P EA. <br />BATHTUB <br />I REFRIGERATION UNITS—H.P. EA. <br />_ <br />LAVATORY WASH BASIN( <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.-.U. M <br />LAUNORYTRAY <br />_ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />I AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL { <br />PERMIT { <br />PERMIT { <br />TOTAL FEE { <br />TOTAL FEE IT <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMDLR <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO <br />TUSEZONE <br />LOTADEA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />B <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />OTHER <br />APPI'CATION ACC BY <br />PLANSCHECkED BY <br />APPR. FOR ISSUANCElY <br />PENALTY <br />�c <br />TOTAL <br />l� SLLLo <br />is ,L1.UF;IIAaaT <br />A/ILl6-� I-I-Te<JE ,D.ph7%CPIP-+In'LL+ <br />1r7,q _8T <br />