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IM Ewrol"PT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />�''6PPLlCA,TIC)►V FO+•�' evereN <br />CONSTRUCTION �1 <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />❑ COMBINATION <br />Ll BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />IkAo 4�°� Si. <br />CITY ZIP <br />C✓rrt i} IS1,01 <br />PHONE <br />r9 SIo6 <br />ARCHITF.C•1 RDESIGeF.R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR 1 <br />Nf'At � CP^S 11 rTWL{ I,o^ <br />MAIL ADDRESS <br />33PP Chgsljil 11 <br />CITY <br />E✓tre•L <br />ZIP <br />gT20I <br />PHONE LICENSE <br />;,�q •F11 R 1 <br />MECHAN ICAT CONTRACTOR <br />MAIL ADDRESS/7 <br />CITY <br />ZIP <br />PHONE LICE14SE K <br />1 <br />E✓tfatPfn 51aTz SiTPT7 JY�t�a� <br />�.:...J.�'. <br />Pn• V1F Is9s <br />k✓PF217 <br />City <br />'?X;Zp6 <br />ZIP <br />_�s7'3!!y FV_F R-GS-S?r2D13 <br />PITONS LICENSE <br />CLASS OF WORK <br />❑ NEW J. ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ RUILDING RELOCATION <br />VALUA71ON OF WORK (COS r OF MATERIALS PLUS LABOR) <br />", -I Lixs. or, <br />DESCRIBE WORK <br />11 ,/ A CT .�e •.•. <br />,1 _ <br />USE OF BUIplNR 1 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />I( �'?A l 0_ 7<rs <br />PLICATIONAND KNOWTHESAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERN:NG THIS TYPE <br />LEGAL DESCRIPTION OF P'-I:'ERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT__BLOCI(--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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />GNATURE OF CON7RACTO'1 OR AUTH IZED AGENT DATE <br />Xl-a6.k7 <br />PROJECT ADDRESS <br />APPLICAN 5 C'.TY 8U.31NESS LICENSE NO. <br />Imy 1�"� S'ireef <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H P. EA_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />_ <br />SHOWER <br />_ <br />GAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />_ <br />KITCHEN . -INK A DISP. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. 4p C C <br />(, <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />I <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />_ <br />-WAISR�Hfi,eiR <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />,IOR DRAW <br />AIR HANDLING UNIT— C.F.M. <br />T _ <br />-Ft <br />VACUUM BREAKERS <br />STOVE <br />ROOF GRAINS—RAINLEADERS <br />_ <br />_METAL FIREPLACE 8 CHIMNEY <br />— <br />SINK ISERVICE—BAR. ETC.) <br />WOODSTOVE//FIREPLACE INSERT <br />R •�--�-1P- Imo_— <br />— <br />_ <br />— <br />SUBTOTAL <br />SUBTOTAL 5 <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTAL FEE It <br />TOTAL FEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'RONT SETBACK <br />BFAR SETBACK <br />SIDE SETBACK <br />PLANCHLCB NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />SEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE 1— <br />'(PE OF CONS T. <br />CCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING $ <br />RZE OF BLOC NO OF STORIES MA%. OCC. LOAD — <br />PLUMBING <br />MECHANICAL <br />TIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />— OILIER <br />PENALTY <br />'.PPLICATION ACC BY PLANSCITECNEp BY f P 'PR. FOR ISSUANCE BY <br />TOTAL <br />