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'.:.aPPLICATION FO.a <br />cm or <br />IA'E"° CONSTRUCTION <br />of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDING O MECHANICAL Al PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CRY C�ZIP PHGNE <br />ARCHITECT o.SIG ER MAIL ADDRESS CITY 1 ZIP PRONE <br />GENERAL CONTRACTOR MAIL <br />`fADDRESS CITY ZIP PHONE LICENSE <br />,iLl • �C"�1'A�LASAI f"'iy <br />�EC ANICAL CONTRAGRiq MAIL ADDRESS CIIV ZIP PRONE LICENSE <br />I� <br />PLUMRRIOCONVMCIOR �., MAIL ADDRESS CITY ZIP PHONE VI�T STVt/i <br />❑ NEW 0,ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/F RPL. INSERT ❑ BUILDING RELOCATION_ <br />MEDIATIONOF WORK (COST OF MATERIALS PLUS LABORI <br />O E SC R I�e/E,,W!1O R N <br />USE OFF BUILDINGV I, <br />040 (yI� (° <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATO AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL DE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT C ES 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 />SIGNATUREOF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY IS14OWN BELOW OR AITACH FOUR COPIES) <br />LOT_BLOCK_ OF <br />PROJECTADDRESS S r—r <br />,} 1 <br />APPLICANTS CITY BUST SS LICENSE NO <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />_MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />_ <br />WAIER CLOSET ITOILET) <br />_ <br />COND. UNITS—H.P. EA. <br />_L <br />BATHTUB <br />_AIR <br />UNITS—H.P. EA. <br />_ <br />LAVATORY (WASR BASIN) <br />-- <br />_ <br />_REFRIGERATION <br />BOILERS—H.P. EA. <br />_ <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <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 />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />_ <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />_ <br />ROOF DRAINS—RAINLEADERS <br />_ <br />_ <br />-- <br />_STOVE <br />METAL F'IREPLACLE CHIMNEY_ _ <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />_ <br />PERMIT 9�_ <br />PERMIT f <br />TOTAL FEE 3 <br />4L1 <br />TOTALFEE $ <br />FRONT SETBACK <br />USEZONE <br />TYPE OT CONST. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK <br />LOT <br />BRZAL <br />SIOE SETBACK <br />VACANT SITE <br />LIVES ONO <br />MAX OCC LOAU <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENAL7Y <br />TOTAL <br />PLAN CHECK FEE <br />FEE I RECEIPT NO <br />_FEES VALUATION FEE <br />E <br />