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MWPLICATION FG t <br />the I9INR <br />CITY Of <br />CONSTRUCTION <br />pn o <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />4' I irn El0 <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ® BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />IP PHONE <br />OWNER MAIL ADDRESS CITY Z <br />/hn 17' .f/.____) e94—/7r? 7tk �Itr. <br />MECHANICAL CONTRACTOR MAIL ADURE55 .... -- <br />PLU M BIND CONTRACTOR MAIL ADDRESS CNN ZIP PHONE LICENSER <br />CIASSOF WORK <br />❑ NEW ® ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 9 WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORN ICOST OF MATERIALS PLUS LABOR) <br />/9Sao.nv <br />DESCRIBE WORK <br />`'Y X 3G GZNif-lC�!!hA •a c' __-. _ <br />USE OFBUILOING <br />I IIEREBY CERTIFY THAT 1 HAVE READ AND EY.AMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVER NI NG THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LEGAL DESCHIP110N OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT— _BLOCK --OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/ <br />ANY 0THERSTATEORLOCAL LAW REGULATINGCONSTRUCT ION <br />tr7 r% -S/ = <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />/ T - / fC <br />- <br />/ <br />(Jllc�z <br />NO <br />11LZ <br />PROJECTAODRESS <br />AFPUCAN FS CITY BUSINESS LICENSE <br />/ <br />%%9 —'1 0 1 f �2�iG� <br />/ //C— <br />— <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />/ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H. P. EA. <br />REFRIGER UNITS—N.P. EA. <br />- <br />BATHTUBATION <br />BOILERS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />GAS FIRED AC. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEMS—B.T,U. M EA. <br />KITCHEN SINK & DISP. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />UNIT HEATERS—B.T.U. M <br />_ <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />— <br />J/ <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />- <br />/ <br />WATER HEATER <br />- <br />VENTILATION FAN <br />-- <br />URINAL <br />-- <br />_ <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />_ <br />AIR HANDLING UNIT— OF.M. _ <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />STOVE <br />METAL FIREPLACE & CHIMNEY <br />RGOF DRAINS—RA!NLEADERS <br />_ <br />WOODSTOVE/FIREPLACE INSERI <br />SIIJK{SERVICE-BAR ETC) <br />oc <br />SUB TOTAL S <br />SUB TOTAL <br />PERMIT S <br />PERMIT $ <br />S <br />Z <br />coo <br />TOTAL FEE S <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL. <br />FRONT SETBACK <br />REAR SETBACK <br />4 d <br />�•"�" �� �� <br />FEE /7 3-3 <br />% �- <br />REC IPT NO <br />USE ZONE <br />ce- I <br />8-1 <br />LOT AREA <br />/1/ 32S <br />FEES` <br />VALUATION <br />FEE <br />TYPE OF,C`ONST/ <br />-� -N <br />OCCUPANCYGROUP <br />!1' .3 <br />NO.G UNITS <br />id;;5 <br />BUIl01NO <br />S/ /SIZE <br />OF BLDG <br />ta <br />7 FaLJ <br />NO. OF STORIES <br />PLUMBING <br />FIRE SPRINKLERS REOUIREU ❑ YES g NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATIGV ACC BY <br />PUNS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />/ S� <br />ex)TOTAL <br />14y <br />J <br />