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FM Evwgr"n <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />t-.PPLICATION FO1 I <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />0 DEMOLITION O COMBINATION ❑ BUILDING '(MECHANICAL <br />OWNER MAIL ADDRESS CITY ZIP <br />MAIL <br />CITY ZIP <br />❑ PLUMBING ❑ SIGN <br />,2� 11t�bsAl ' l tY)t lCG7�7� 11 JyArt I",�t`�� C_ 1rii��-+ Yvf-t �f,,a- �z-Ab <br />MECHANICAL CONTR ETCH MAIL ADDRESS CITY LP PNONE LICENSE • ' <br />(mil i/-t4 .tl n I.TD 3Ph! N . . lA A �31 A54-277n D� 51 1��L212o� <br />PLUMBING CONTRACTOR MAIL ADDRESS C, ZIP PHONE LICENSER <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OFMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />DE4CH19EfWOnK <br />F IVA / ✓__. .�1/ 11�/Mi�L11I. 1-iTI ) <br />USE OF BUILDING <br />ART -rn 1.1 ffL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW TH L- SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. �_� A <br />SIGNA R^E Of CONTRACTOR O AUT IZED AGENT DAT `i Cl <br />tf/ <br />LEGAL DESCRIPTION OF PROPERTY ISHOWNBE 1WORATTACIIFOURCOPIESI <br />LOT — BLOCK- OF <br />PROJELTA DpES� <br />S/Vl l <br />APPLI(:ANT'SCIIY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT I <br />FEE <br />WATER CLOSET TOILET) <br />Ai C — A/HNOLG UNITS jM.' RIM <br />BATHTUB <br />LAVATORY I WASH BASIN) <br />BOILERS — B.T.0 /H.P. <br />SHOWER <br />GAS FIRED ABC. UNITS — STILL <br />KITCHEN SINK A 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 />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERM <br />, <br />TOTAL FEE <br />$1 <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE i <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />...1 <br />SIDE SEI RACK <br />USE; INE <br />LOT AREA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <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 />/Op <br />r1 <br />✓ <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPI ICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR 155UAN6E SY <br />PUBLIC WORKS <br />TOTAL <br />cno nFTFRMINIAIC. AL I. <br />r <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />