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Ai?PLICATION FOR <br />the EYBFprASR CITY of CONSTRUCTION Ee <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-E810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />F>�Y7'�1 JocY_. D�st�wcrr 4730 ccxBy JAVe. F7T tLs. 3 311 +210 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERA COF.RACTOR MAIL ADDRESS CITY ZII' PHONE LICENSE A <br />MAIL ADDRESS CITY ZIP PHONE LICENSE <br />q PLUMBING CONTRACTOR MAIL ADDRESS CITY ZLF <br />1 <br />CLASS OF WORK �I( <br />❑ NEW ❑ ADDITION ICI ALTERATION Cl REPAIR ❑ DEMOLITION <br />I <br />I ICENSE . <br />❑ WOODSTOVE/FRPL.INSEHT Cl PUILDING RELOC;TION <br />USE OF BUILDING <br />I, oiw <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND 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 />TAl E OR LOCAL LAW REGULATING CONSTRUCTION <br />O TH F CONSTRUCTION. <br />Si AT E OF CTO R UTHORIZED AGENT /� DATE <br />f9114L"/ <br />I <br />I LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT— SLOCK__OF <br />l <br />,YPROJECT ADDRESS (�Q <br />1 D 1 W <br />` <br />AP ICAN .5I IS ESS LI ENSE NO <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 — A/HNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B T.U. <br />KITCHEN SINK 6 OISP <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 />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOC STOVE <br />SINK (SERVICE —BAR. ETC.) <br />METAL FIREPLACE A CHIMNEY <br />V ju .5(ALJF <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />'- <br />TOTALFEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />PLAN CH CK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />USEZON4E <br />✓I A + <br />LOT AREA <br />/ K/ai Sr` <br />VACANT SITE <br />VACANT <br />OYESNO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF COrL�SAT�F�- <br />�•Ltl Ajr <br />OCCUPAGROUP <br />NO OFDINFLLING 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 />APPLICATION ACC BY <br />PLANSCIIECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />_ <br />TOTAL <br />PHUPtH n UwNcna nnc ncorv.......-- .............._..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />