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IN EHLpFNn •-tPPLICATION FOiv' ki <br />Glry°` CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />Li DEMOLITION ❑ COMBINATION 'BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />iQj�n�o l.11c- /71/S J'i»oKfy 41•y� /het. y'�yP23 (S3-YSSS <br />ARCHITECT OR DESIGNER _. <br />GENERAL CONIRACTOR <br />SiinTr <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />14ANICAL CONTRACTOR <br />_ <br />MAIL ADDRESS <br />•CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />— ZIP <br />PHONE <br />LICENSE• <br />❑'NEW u^^❑ ADDITION MALTERVION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/GRPLANSERT ❑ BUILDING RELOCATION <br />VA;. UATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />?/ oc)eD <br />DESCRIBE WORK <br />IJ.IE OF BUILDING <br />SI u f'N LOAJ t <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE TY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER OSTIATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON/ACT/OR OR AUTTHORIZEOA ENT DATE <br />LEGAL DISCDTrnoN OF PRGP RIY(SNOWN DELOW OR ATTACH FOUR COPIES) <br />LO/_BLOCK­ OF <br />YSO 5-IY 'Y /�bf S. E. <br />( l <br />LS•UY �f J ���Z <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICINEE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF DGUIPMENT <br />PEE <br />WATER CLOSET (TOILE D <br />_ <br />AIR COND. UNITS-H.P, EA. <br />_ <br />BATHTUB <br />_ <br />REFRIGERATION UNITS-1 I.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED 0.L UNITS—TOIJNAGE EA_ <br />KITCHEN SINK 6 OISP. <br />FORCED A:R SYSTEMS—B.T.U. IA EA. <br />DISHV!ASHER <br />WALL HEATERS--B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—U.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER _ <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING ',OUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK IDERVICE—BAR, ETC, <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTALMS <br />SUBTOTAL S <br />PERMIT <br />PERMIT S <br />__ <br />TOTAL FEE <br />TOTAL FEE $ <br />USE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEP1 <br />REARSETBACK SIDE SETBACK PLAN CHECK NUMBER <br />-)Y/`� <br />LOTAREA <br />VACA/ <br />DYES ONO SITE <br />OYES <br />_ <br />FEES <br />CC:UPANCYGAOUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />NO OI STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />RED OYES ❑ NO <br />MF-CNANICAL <br />OTHER <br />PENAL"iY <br />PLANS CIIEGNED BV <br />APPq. FOR ISSUANCE BY <br />TOTAL <br />'ERSONNEL <br />PLAN CHECK FEE <br />FEE RECEIPT N0. <br />VALUATION FEE <br />S <br />L, <br />U <br />