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1 <br />E�ro�,R `"PPLICATION F0►% btj� <br />the CONSTRUCTION <br />everett PERMIT 161 <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION Vil BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />MOWNER <br />lrDM� ,cawal,ayiyrmnt+ <br />MMI ADDRE59 <br />L4000,i�+IfiM16�A�t*3 +,D1 <br />CITY <br />>r <br />71P <br />`l�wl <br />PHONE <br />ZS`1 �135'� <br />ARCHITECT OR DESIGNER <br />.1iI,A k w,A�, hvF�ikcit <br />MAIL ADDRESS <br />I(oo-I-ftwIttm%5s Im 400 <br />CITY <br />EvtvPteit <br />SIP <br />9bw1 <br />PHONE <br />�°I 31b <br />,GENE RAL!CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />SIP <br />PIONi b�� EILi <br />ko mob1D1'-�G <br />D �Tg FN6 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />L <br />PLUMBING CON TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />FRONT: LICENSE A <br />CLASS OF WOR' <br />Cl NEW ❑ ADDITION 0 ALTERATION ❑ REPA.R ❑ DEMOLITION ❑ WOODSTOVE/F RPL. INSERT ❑ BUILDING RELOCATION <br />IMftVUnlENT'S <br />USEE,orr BUR1�D•ING <br />U FI <br />I HEREEIV CERTIFY THAT I HAVE READ AND EXAMINED THIS AID- <br />PLCATON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRE: UME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATED LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFO CE OF CONSTRUCTION. <br />SIGNATURE D T O Ul 0/A/GEE/NTT DATE <br />V 411167 <br />(/�/�� <br />LEGAL DESCRIPTION OF PROPERTY I9NOWNBELOWOR ATTACH'OUR COPIE 91 <br />Iq T2U,a.I %6 lhT aF EVevzm- d�' <br />LOT_BLOCKOr <br />PROJECT ADDRESS <br />32?s� J+1M012E ME £tj-Eif WIC 982'D) <br />AP LICA SCITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS-H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H P EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H P. EA <br />_ <br />SHOWER <br />FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />_GAS <br />FORCED AIR SYSTEMS-B.T.U. MCA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <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 GRAIN <br />AIR HANDLING UNI'- CF.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE-BAR,-BAR, ETC <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />— <br />SUB TOTAL <br />PERMIT ! <br />TOTALFEE ! <br />SUBTOTAL ! <br />PERMIT t <br />TOTALFEE ! <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />(0 <br />D17 17?e? <br />PLAN <br />FEE 17d: <br />CHECK FEE <br />RECEIPT NOE955L7 <br />USE ZONE <br />LOT AHFA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />— <br />I <br />('/'L� <br />✓ V <br />TYPE orrTCONS, <br />. 1 <br />.L' - N <br />OCCUPANCY GROUP <br />I'P "Z <br />NO . OF DWELLING UNITS <br />•a— <br />BUILDING <br />S <br />SIZE Or BLDO QOv�v <br />F121 Cn c, i.�� <br />N O OF STORIES <br />Z. <br />MAX OCC LOAD <br />I.5 rr <br />PLUMBING <br />--- <br />MECHANICAL <br />OTHER <br />PENALTY <br />It ICA71ON ACC BY PLA14S;HECKED BY APPR FOR ISSUANOEBY <br />� J �A TOTAL <br />ALUHTB'!/Ij ��NiT IIIECNA.U_7f/IL �Fq`71i� <br />ATE DBE 'Jbi,�ING1� $1=P,4RA'TCLY <br />