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rlPPLICATION FOL-' <br />The <br />191Nn Cin OF CONSTRUCTION <br />lTr of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK - :P�LEA PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL <br />MA'I. <br />CITY <br />zip <br />c �-1✓�- <br />7� �VC�1Y " <br />❑ PLUMBING ❑ SIGN <br />PNONL <br />KNEW ❑ ADCIIION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSIOVE/FRPLANSERT Cl BUILDING RELOCATION <br />VALUATION OF WOnv C. )ST OF MATT RIALS PLUS LAROnI <br />�q- <br />OE�SCmn L{wof e.� <br />usf of Bw Du+r, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHE SAMETO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILL BEC MPLETEDWITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE NTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHO O VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHE EORL AL LAW REGULATING CONSTRUCTION <br />OR THE P O ANC F CONSTRUCTION. /� <br />SIGNATU E C TACTOPI A UTHOPIZED AGENT DATE o,705A <br />P IC 1'S SINESS LIC VlG[ND u-'�J�LJ <br />LEGAL DESCRIPTION OTPROPEnFY ISTIOWN BELOW ON ATTACH FOUR COPIES? <br />LOT_BLOCK --OF — <br />PROJECT ADDRESS <br />Is S4k <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 (TOILET) <br />AIC — A/HNOLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS —H P. EA. <br />LAVATORY (WASH BASIN) <br />.T <br />BOILERS — BU,H P. <br />SHOWER <br />GAS FIRED A.C. UNITS — B.T.U. <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS — B.TU. 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 />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />EACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE —BAR. ETC) <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE WSERT <br />HEAT PUMP <br />CAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />I nONi 5[TDaCI'. <br />ALAN SE *BACK <br />SIDE SETBACK <br />USE ZONL <br />LOTAPEA <br />VACANT SITE <br />❑YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$ <br />TYPE OF LONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />PLUMBING <br />SIZE OI BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />AP{'I ICA11(IN AI:C OY <br />Iq INS CHECKED BY <br />APWI FOR ISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />PROPERTY OWNtH5 AHE Ht8PONtAULE I UH UET ERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />