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r.PPLICATION FOL <br />CITY rho CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE FRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING I MECHANICAL ❑ PLUMBING ❑ SIGN <br />E,RMAIL ADDREd3 CITYZIP PHONE <br />Y�- MAY O _" I "-L 11u1 V�IrE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHAWULCONTRACTOR MAIL AHUHCSy CNY ` ZIP PHONE Ocr-jr,. <br />� . It -`A J ill ADDRE39 l� OKI �_IkC %"C L-I f.,In 11 :' T % i�1 UI ILL "I <br />PLUMBING NIRACTOR MAIL CITY ZIP PHONE LIC..YIIt- <br />CLASSOF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEJFRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORr ICOST OF MAIL RIMS PLUS LADORI _. <br />USE OF BOILO G,_ I <br />I HEREBY CERT;;:Y THAT 1 HAVE READ AND EXAMINED THIS AP. <br />PLICATIONAND KNOW THE SAME TOBETRUE AND CORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPF <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 V OLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE F CONSTRUCTION. <br />SIUNATURE OF CONTRAC Rp— AUTH O RIZEDAG E N T DATE <br />i <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PROJECT ADDRESS <br />51 ac)- -1-," (--A-e <br />APPLICANTS CITY BUSINESS LICENSE 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 ITOILETI <br />A/C — A/HNOLO UNITS — H.P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />_ <br />LAVATORY I WASH BASIN) <br />BOILERS — B.T U /H.P. <br />SHOWER <br />GAS FIRED A C. UNITS — B.T.U. <br />KITCHCN SINK A DISP <br />FORCED AIR SYSTEMS — B T.U. ': J 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 />j 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 />,� <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />W. <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUBTOTAL s_ <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />I RUNT SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT ARLA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONSt <br />OCCUPANCY GROUP <br />NO OF pWFlLINO UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />LI/AX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATIONACC By <br />PIANSCHECKED BY <br />APPD FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNE9S AHL HE5PU'4SIULt VUH Ut It HNIININU ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASELIENTS. <br />