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the Evorgtwn <br />CITY OF <br />everett <br />i BUILDING DEPT. <br />259-8745 <br />APPLICATION FOR <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />❑ COMBINATION 0 BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />CITY 21P PHONE LICENSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />1 MECHANICAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />B <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION J' ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />UANDN OF WORK ICOST OF MATERIALS PLU� Raop' <br />�a � /o. o o o <br />Ul SL�Itl[ WOI K / I( <br />/] p(// 'iL.21FTLl(iAj(Un G' Id a Mll 011 JtRG O <br />T Nw' <br />USE 0 BUILDING <br />I 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 />- <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />'h9.('� <br />t Z <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE <br />NOT PRESUME TO <br />I 1v <br />IN OR NOT. THE GRANTING OF A PERMIT DOES <br />LDi� eI �cK�_oF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE AUTHORITY <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION, <br />— — <br />SIGNATURE OF CON TRACTOOR' of AUTHORIZED AGENT DATE <br />X �' <br />v�LCt ! ' <br />APPLICANTS CI TYBUSU �.� ENSETIO <br />PIIpJECi AOnnORESS <br />/I <br />I�`1 1�`7 <br />PLUMBING <br />_ <br />FEE <br />MECHANICAL -- <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />10 <br />. <br />AIR CONDUNITS-M <br />`j' WATER CLOSET _(TOILET) <br />REFRIGERATION UNITS-H. P. EA. <br />_ BATHTUB ---�- <br />ICE Cu_ <br />BOILERS <br />LAVATORY(WASH BASIN) <br />GAS FIRED A C. UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B.T.U. <br />SHOWER <br />_ <br />KITCHEN SINK 8 DISP. <br />WALL HEATERS-8 T.U. A <br />_ <br />DISHWASH_ER <br />UNIT HEATERS-B.T.UHEATERS-B.T.U. M� <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />U <br />CLOTHES DRYERS <br />WATER HEATER <br />ti <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HAKILING UNIT- C.F.M. <br />FLOOR DRAIN _ <br />STOVE <br />VACUUM BREAKERS <br />METAL JL CHIMNEY <br />HOOF DRAIWi-RAINLEADERS <br />TOVEIFIRCPIRE ACE INSERT <br />_ <br />SINK SERVICIi-BAR ETC)WOODSTOVE/FIREPLACE <br />- <br />U_ <br />SUBTOTAL S <br />SUB TOTAL <br />• �' <br />---- <br />PERMIT S <br />PERMIT S <br />_ <br />ZZ <br />L <br />__ <br />TOTAL FEE S <br />TOTALFEE___S <br />_ __ _ <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING <br />DEPT. PERSONNEL <br />SETBACK <br />PEAfl SETBACK <br />SIDE EETBALK <br />CBER <br />PLAN CHECK NUM <br />/T�•�^ PLAN CHECKFEE <br />FEE q G <br />pN <br />O Y�/ 3 6 (,q <br />/ <br />INE <br />LOT AREA <br />VACANT SITE <br />! FEES <br />VALUATION <br />FEE <br />OYES ONO <br />BUILDING <br />S <br />SIZE OF BIDG <br />b0 OF STORIES <br />uAX. OCC. lOAO <br />PLUMBING <br />FIRE SPRINKLERS REOUIRED ❑ YES ❑ VO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY I PLANS CHECKED BY <br />APPA FOR ISSUANCE BY <br />TOTAL <br />E(Hr� <br />I <br />