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� ...PPLICATION FO..' YCFlif <br />the "" CITY 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 f1PLUMBING ❑ SIGN <br />O21 11 / MAIL ADDRESS . / CITY /J ZIP PHONE <br />�%JEiC.//�rLJyL <br />I <br />Anrun Fr, rIWD� MAIL ADDRESS CITY ZIP PHONE <br />OENERALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE• <br />PLUMBING CONIRAOTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />U ALTERATION Cl REPAIR <br />❑ DEMOLITION <br />❑ WOODSTOVE/FRPLANSERT ❑ <br />BUILDING RELOCATION <br />vALVATIPNoFWonKICOSIOFPAAN.NIALSPLUSuoo I <br />LL I rt ij I <br />(: CII <br />DESCRIBE WORK <br />-I-.I.. /.. I ` <br />r <br />,1 1-,•..1 f r, J1�]nt- <br />r <br />USE dF BUILDING f1 <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 />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <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 CONTRACTOR On AUTHORIZED AGENT DATE <br />i <br />X!�!l�Q_..0 / <br />APPLICANTS CITY BUSINESS LICENSE , <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW ORATTACR FOUDCOPIESI <br />LOT._BLOCKL OF <br />PROJECT ADDRESS 1/ 1_ <br />///� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS—H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />_ <br />_ <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK 6 DISP, <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />a. C- LI U III f r(,L— <br />SUB TOTALS <br />r, <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />C <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK BEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />USE ZONE LOT AREA VACANT SITE <br />OYES ONO FFcS VALUATION FEE <br />OF BLDG <br />FIRE SPRINKLERS <br />;ATION ACC BY <br />ur]byL 1III*.-I— II:J:L'Sxa K-n-1 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S <br />11 <br />oc) <br />