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,APPLICATION FOk. <br />the °'"" <br />CRY OFCONSTRUCTION O <br />n of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />DEMOLITION ❑ COMBINATION IN BUILDING ❑ MECHANICAL ❑PLUMBING ❑SIGN <br />MAIL CIIV 111• PrlOr1V <br />OWNER _ T U :? /I !!1 f L� .X ' ��`1 -) I I i <br />I�I/G'L-11 `1iie.Ll _ <br />Agf,T OR OESrGNFR MAIL AD11R1 55 Clly :Ir PIIO41 <br />�'-Y/IUE.ryRAL ` :- •'CrA� iY ). CK•. i4:_�� - <br />' - <br />GENERALCONTRACTOR MAIL aD11REo5 ZIP n <br />blv UORT LICN15f <br />1 E ✓�'—TINT.` _.CrT.I':Ck—1iC.rl•Ji :crr ,t',ci G 11 <br />lZFrrrAN4Al bgPRAr TIIpi MAIL AI 55 CNT ZIP PHUNI: InIE NSr . <br />n!6u.J Lnl. 345L0 <br />Cuss 01 W1JR- <br />❑ NEW ❑ ADDITION ❑ ALTERATION I REPAIR ❑ DEMOLITION ❑ WOODS70VElrRPL.INSERT ❑ BUILDING RFLOG1110N_ <br />9AL UAT011 nF WOP. NCO ,I Gr .rqH N'AI •, rl US I ARORI <br />I I �11 1(' <br />orS C BWORT( ../, <br />J fl l, r :J 1,1 11 ). <br />USE Or Bun DNIO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND L:ORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI£TYPE <br />9r PROPEnInSnOWN 9EWWONMUCH IOIID COPYS' <br />1117IJE%RIPIION <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IOTA_ BLOCK_ or <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 P1�RFORMANCE OF JONSTRUCTION. <br />SIGN pON I]ACTOR Oh UH ON2ED AGENT OAtE <br />TORE <br />X � <br />—� <br />APPLICAN TS CITY BUSINE 55 LlCfrll:E NI <br />PROJECI ADDRESS <br />{ <br />7 r <br />MECHANICAL <br />PLUMSING <br />NO.E <br />OF FI%TURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMEN7 <br />FEE <br />AIC - AIHNDLG UNITS - H.P <br />T (TOILET) <br />REFRIGERATION UNITS - H P. EA. <br />ASH BASIN] <br />BOILERS - B.T.0 /H F. <br />CAS FIRED A.C. UNITS - B.T.U. <br />FORCED AIR SYSTEMS - B.T U. MEA <br />A DISP <br />,O,RY(WASH <br />WALL HEATERS -B.T.U. M <br />UNIT HEATERS - B T U M <br />UNDRY TRAY <br />EVAPORATIVE COOLERS <br />CL0T1'ES'NASHEP <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR GRAIN <br />BACKFLOW PPEVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />METAL FIREPLACE Al CHIMNEY <br />SINK (SERVICE - BAR. ETC) <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL f <br />SUBTOTAL <br />f <br />PERMIT f <br />PERMIT <br />TOTALFEE f <br />TOTAL FEE <br />PLAN CHECK NUb.BER <br />FEE <br />RECEIPT NO. <br />nLen$r.fDAGK <br />510E SETBACK <br />1 ngNf SElpu:r <br />USE ZONE <br />IOT AnfA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />S <br />DYES ONO <br />— <br />BUILDING <br />I It Or CONS] <br />O' r. IIPANCr C EOUP <br />140OrDWrLLINGUNNS- <br />PLUMBING <br />517E Or Ill Or; <br />NO or STOPIE$ <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED LI YES U NO <br />STATE ENERGY SURCHARGE <br />mrPl rl,a4ON <•:C R. <br />nl rC/. CUECv[b ar <br />Arl'n IOri lSsuaNGt Rr <br />PUBLIC WORKS <br />i <br />TOTAL <br />At 1. <br />I <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />