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r.PPLICA►TION FOI. <br />CITE"'°'"" <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION O BUILDING Yj MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />ABCHI CTOR DESIGNER .7 <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIIUNt <br />LICENSE• <br />GENERAL CONTRACIOR <br />MAIL ADDRESS <br />CIFY <br />ZIP <br />PI:ONE <br />NFCNAIUMAI CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />_ ZIP- <br />_ PIIOHE <br />LICENSE <br />❑' NEWV^ ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORK ` / <br />-nn l w i / �i-E T vnn nP /.ThS Eill� U_1/I�f'li <br />-- <br />'44 <br />EOLD., <br />UG- <br />�-•• n / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />_ <br />�i1.._ <br />E�{_�j IGU <br />PLICATION AND KNOW THE GAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY (SNUWN BELOW OR ATTACH FOUR COPIEF) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT- 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />5olg - 2-p'h ,4 t) e,, a) F U-'e <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-M.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H P. EA <br />LAVATORY I WASH BASIN) <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.0 EA. <br />L <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />-_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />46 <br />VACUUM BREAKERS <br />_ _ <br />STOVE <br />-0 <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />- <br />0 <br />SINK (SERVICE -BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />Y <br />c' <br />� <br />p113Q <br />✓ <br />_ <br />SUBTOTAL_ <br />SU9 TOTAL 3 <br />_ <br />' <br />PERMIT ! <br />MIT 3 <br />PER - <br />TOTAL FEE ! <br />.) <br />s <br />TOTAL FEE <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />;EAR SE 18ACK SIDE SET BACK PLAN CHECK NUMBER PLAN CHECK FEE <br />1� I FEE RECEIPT NO <br />'jLOI AREA VACM TSITE FEES VALUATION FEE <br />OYESONO <br />OCCUPANCY GROUP <br />SIZE OF BLDG. <br />MIX. OCC ICAD <br />UNITS <br />4PPLICAIION Y <br />CIIEGNEU BY <br />FOR ISSUANCE BY <br />IPLNIS <br />IAPPR. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />3 <br />