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P%PPLICATION FOkJ <br />the °"'" cl"OF CONSTRUCTION <br />CITY OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWIIEn MAIL ADDRESS CITY ZIP <br />---? J _..".81 (%C/), <br />❑ PLUMBING <br />PHONE <br />IrYETeTI <br />e <br />❑ SIGN <br />ARCIII IECf OR OE SIGNEn <br />MAIL ADDRESS <br />CITY <br />LIP <br />✓Hove <br />LICENSE• <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ME. CHANICAL CONTRACTOR <br />MAIL ADDRESS <br />DI Ty <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBINHCONTPACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />�L"a " F�T� <br />❑ NEW I(a ADOITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WOTIK ICOST OF MAICnIAtS PLUS LABOR) <br />�NSEMJH WORK <br />(1 <br />USr: OF8,y/ILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AR <br />S u.4 (.. <br />PLICATIONAND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />c�m <br />1 I HALL DESCnIPUON OF a PY15F10WN BLLAw OR ATTACH FOURCOPIES) <br />-J_ t-,f L• f!,(Lf'� <br />we <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />C, <br />OI_BIOr,IN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/ <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />�LIrII 111"Lti <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONI FACTOR OR AUTH R12ED AGENT DATE <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENS O <br />PLUMBING _ <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET ITOILET) <br />5'U� <br />AIR COND. UNITS-H.P.EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />_ <br />�- <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. _ <br />- <br />SHOWER <br />GAS FIRED AC. UNITS-TON14AGE EA <br />_ <br />-�_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />._= <br />URINAL <br />VENTILATION FANS <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />BREAKERS <br />STOVE _ <br />- <br />_VACUUM <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 3 CHIMNEY <br />__ <br />SINK ISERVICE-BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />C O <br />o-� <br />SUB TOTAL S <br />SUB TOTAL <br />_— <br />PERMIT 3 <br />_. <br />II�' <br />PERMIT 3 <br />_ <br />TOTAL FEE 3 <br />//- <br />�r <br />1 <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I HOIII SI'. TRACK <br />HEAR SETUACK <br />I/G <br />SIDE SETBACK <br />PLANCHECKFEE <br />FEE /�Otli <br />ZONE <br />LOT AR!.A <br />LrFw! <br />VACANT SJTE <br />AYES 3x000NSI <br />VALUATION <br />FEE <br />ffP�L�ANCHECKR <br />r <br />OL:CUPANCY GROUP NO. OF DWELLING UNITS <br />SR OI III L(L NO Of STORIES MAX OCD LOAD <br />I� JrOAo'f I <br />FIRE SPRINKLERS REQUIRED U YES JANO <br />SY�jLtiLl• <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />AIR') )CATION ACC BY <br />LA-7 <br />BT APPF. FORISSUANCE OY <br />/,G <br />TOTAL <br />