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EL7FpF»n <br />a <br />.:PPLICATION FQ��' �Y�,�IL <br />TM <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />1 <br />BUILDING DEPARTMENT <br />258-BB70 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION <br />s <br />❑ COMBINATION ❑ BUILDING MECHANICAL PLUMBING ❑ SIGN i; <br />OWNER <br />�y <br />RAIL ADDflE55 CITY ZIP PITONE <br />�iS�• "a Y730 (2 �dE. <br />e� <br />.Sciiso( Zhy i <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITYZIP PHONE <br />S <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE X <br />MECHANICAL CONTRACTOP <br />MAR ADDRESS CITY ZIP PHONE LICENSE F <br />C R -;C- 7 JR.B <br />PLUj�q1KING CONTRACTOR <br />MAIL ADDRESS CI1Y ZIP ZONE LICENSE <br />(�kr4Cik <br />15 ,50. JCA� r+egL�303� 8Sf33So <br />' CLASS OF WORK <br />❑ NEW ADDITION <br />❑ ALTERATION ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF f4ORK ICOST OF MATERIALS PL US LABOR) <br />RV <br />DESCRIB ORK <br />Olu.Tl6;. x <br />�Ct3-- e <br />USE F BUILDING <br />— t <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />rAlUR CONTRACTOR R AUTI/ORIZEO AGENT GATES"A� <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR AT TACII FOUR COPIES) <br />LOT— BLOCK OF — <br />PROJECT ADDR S �� <br />U, „ <br />APPLICANT CITY BII IN SSL 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 />— <br />BOILERS — P.T.0 /H 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 — Ell 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 />r <br />'— <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />LA, <br />FIREPLACE INSERT <br />MEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />I I� <br />SUB TOTAL f <br />SUB TOTAL <br />Ill PERMIT f <br />— <br />PERMIT <br />TOTAL FEE f <br />TOTAL FEE <br />FRONT SETBACK <br />PLAN );HECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />5 <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF OWFLLING 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 />APPI ICATION ACC BY <br />PUNS CHECKED BY APPR FOR ISSUANCE BY <br />PUBLIC W06KS <br />TOTAL <br />— <br />PROPERTY OWNERS ARE RESPONSIBLt Fun UL I tHMININU nL.L. <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />