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1A. Evryr••R APPLICATION FOR'�.:; <br />CITY OF CONSTRUCTION <br />everett PERMIT P+ <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />PLUMBING CONTRACTOR MAII. ADDRESS CITY ZIP i-HONE LICENSE. <br />CLASS OF WORK <br />Cl NEW Cl ADDITION Cl ALTERATION ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATI N OF WORK ICOST OF MATERIALS PLUS LABOM <br />4� <br />DE <br />CRIet WORK <br />I' <br />/J <br />USE FBU1101NG' <br />AM/ <br />I H H.:BY CERT Y THAT I HAVE READ AND EXAMINED THIS AP - <br />PLCATIONANDKNOWTHESA O E TRUE AND CORRECT. ALL <br />PROVISION S OF LAWSANDO I N ES GOVERNING THIS TYPE <br />. OF WORK WILL BE COMPLE TH HETHER SPECIFIED HERE- <br />INAn OR NOT. THE GRANT IN ER IT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIO E HE PROVISIONS OF <br />R STATE OR AW EGULAT GCONSTRUCTION <br />OR THE PERFORM E ON RU <br />SIGNATURE OFCO AC FOR THO GENT DATE <br />X <br />LEGALD SCRIPTION OF PROPERTYISVO BELO OR A1iACH FO coPIESI <br />dl _. IJL�� <br />•��ANYOTHE <br />PROJECT ADDRESS <br />160? ow <br />LICANTS CITY BU51 55 LICENSE NO <br />PLUMBING <br />MECHANIC <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 — A/HNOLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H P EA <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.0 IH.P. <br />SHOWER <br />GAS FIRED ABC. UNITS — B T.U. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — B.T.U. M EA. <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 />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOL STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTALFEE sl <br />TOTAL FEE <br />f RUNT SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FIXES LINO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPIICATIONACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />VHUrtM I T uwncnJ HIIC n'a ......vim._......._ .............._..-' <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />