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DPLICATION FOR= <br />CITY OCONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK • PLEASE PRINT <br />259.8810 ❑ DEMOLITION >1.COMBINATION ❑ BUILDING ❑ MECHANICAL <br />LuII ADDRESS CITY ZIP <br />i /i7t13nP]td '//IG. l7/l/ /v ':5V .jyW4 _S:&& Yi/e3 <br />evereR <br />e <br />❑ PLUMBING ❑ SIGN <br />PHONE <br />ARCHIT CTGR DE SIGNER MAIL ADDRESS CITY 21P PHONE <br />DENERAl C�1R MAIL ADDRESS CITY IIP PHONE LICENSEL <br />5fb'w y3 �L <br />ADDRESS <br />CLASS OF WORK <br />I{�uaw O ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />YALUAHON OF WORK )COST OF MATERIALS PLUS LABON <br />QOYU <br />DESCRIBE WORK A I 1 II_... �inIKI 72./1-- /%/n% <br />vim' <br />USE or BUILDING rr <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIPS AP- <br />U 5 .�:Lvokc <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPT ION OF PROPERTY ISHOWN BELOW OR AitACH F OUR COPIES) <br />�I/J�� <br />OF WORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />LOIyJ-BLOCK— OF <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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJ FI(./5777ESy <br />APPLICANTS CITY BUSINESS LICENSE NO <br />I <br />IV ocn j <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 — AIHNOLG UNITS — HP <br />BATHTUB <br />— <br />REFRIGERATION UNITS —H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS —B.T UIHP <br />SHOWER <br />GAS FIRED A C. UNITS — B T.0 <br />KITCHEN SINK d OISP <br />FORCED AIR SYSTEMS — D T U. M EA. <br />DISHWASHER <br />WALL HEATERS — B T.U. M <br />LAUNDRY TRAY <br />IT HEATERS — B.T U M <br />CLOTHES WASHER <br />ATIVE COOLERSURINAL <br />ES DRYERSDRINKING <br />FOUNTAIN <br />ATION FANFLOOR <br />DRAIN <br />MOODBACKFLOW <br />PREVENTERS <br />HEATERROOF <br />DRAINS—RAINLEADERS <br />JK <br />STOVE <br />)SERVICE —BAR. ETC) <br />ISINK <br />/S CHIMNEYACE <br />INSERTUMPPINGSTFAN <br />SUBTOTAL <br />f <br />— <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTALFEE <br />3- <br />REAR SETBACK <br />SIDE SETOA K <br />f <br />CHECK NUMBER <br />PLAN CHECK <br />FEE <br />'% <br />RECEIPT NO. <br />FRONT SETBACK <br />J <br />Zo <br />Z_ <br />6 <br />O <br />16 <br />USE ZONE <br />LOT AREA <br />ACANT SITE <br />FEES <br />VALUATION <br />FEE <br />yYES ONO <br />BUILDING <br />AL <br />ttPi O'f GONSr <br />OCCUPAN vGROUP <br />NO. OF GELLING UNITS <br />PLUMBING <br />cc <br />SIZE Of BLDG <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 />APPLICAT ION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWORKS <br />4/ <br />Yam/ <br />-4 <br />TOTAL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />J <br />ti�A'lIETl•'S'i:J°.. o..�_..,,, ...q.Y' .r .. .... .. .. .. .. <br />