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t.PPLICATION FOk FYEtffl <br />CITYOF mR CONSTRUCTION 0 <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�//��/� �y MAIL ADDRE55 CITY p ,p LIP �PIH-O�NE /� 1 1 <br />O`W,NEDl i��y I^IQ1 Vl.i �,O/� ✓4� `-" . C vere4t. _�L��'tL' <br />V\ILi I�T/Ll ONE 1 <br />City <br />amE RE ­RAL CONTRACTOR <br />y111e /11QIw�aQ <br />MAIL•Puncaa <br />on II�a3+���tIUXLV <br />qq- Everett, <br />9Paoq -3S5- 7736-\JhLL91VG/51L <br />MAIL ADDRESS <br />CITY <br />LIP PHONE <br />CF <br />MECHANIC• CONTRACTOR <br />MAIL ADDRE55 <br />CITY <br />ZIV PHONE <br />(ICE NSE <br />PLUM41N0 DDNTRIDTDR <br />CLASS OF WORT! t <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ClDEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION_ <br />T/ DO.Od / J <br />DESCRIBBEWORK 1 I I 1 -1 / I/ I l� I If-�I I ,`. 1 /. l T: <br />usE BuµoNlor <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECF.All <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TN PE <br />PRO ERTV (SHOWN BELOW OR AitACH FOUR COWESI <br />LEGAL DESCRIPTIONOF <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />Lol_BLocK_oF — <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 />SIGNATURE OF CONTRA TORIOR AUTHORIZED AGENT IIATTE 1� <br />L " " /'I - <t � <br />x 6 , <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C — A/HNDLG UNITS — H.P. <br />WATER CLOSET ITOILETI <br />BATHTUB <br />LAVATORY I WASH BASINT <br />SHOWER <br />KITCHEN SINK A DISP <br />DISHWASHER <br />REFRIGERATION UNITS — H.P. PA <br />BOILERS — B.T.0 /H.P. <br />OAS FIRED A.C. UNITS — B T.V. <br />FORCED AIR SYSTEMS — B. T.U/vT(> M EA <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS —B.T.U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />( <br />WATER HEATER <br />BACKFLOW PREVENTERSiF: <br />ROOF DRAINS — RAINLEADERS <br />: <br />WOOD STOVE <br />":. <br />METAL FIREPLACE •CHIMNEY <br />-- <br />SINK (SERVICE — BAR. ETC) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUST FAN <br />9UB TOTAL <br />SUBTOTAL <br />f <br />PERMIT <br />f <br />P[RMIT <br />TOTAL FEE <br />TOTAL FEE <br />f <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />I RUNT SETBACK Ti IBACK SIDE SETBACK <br />USE LONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />OYES UNO <br />tr PE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWFLLING UNITS <br />PLUMBING <br />IZ <br />SE OF BWO <br />NO OF STORIES <br />Max OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED U YES O NO <br />STATE ENERGY SURCHARGE <br />APPI ICAIION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />_______................ 1 nveolNlIm F rnn OFTFRMININGALL <br />' <br />I <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />