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CITY OfF°,..R CONSTRUCTIONS <br />CITY OF <br />everett PERMIT <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS � CITY ZIP PHONE <br />00uu �u5 recdlr/II c7f .S <br />1 7 4Ile l= / Vevc y82S'-157 <br />c'Cj �5'6 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE -LICENSE 0 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />Y'( NEWv ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION 0 WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />00 <br />i„gTu// c, L,vcud 57`.te <br />USE or BUILDING <br />C �L <br />5 <br />-- <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 />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED 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 Or <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTTHHORRIZE,D AG ENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />tOT- BLOCK _OF <br />Y 1 I y y a <br />wa Sr / f a u f 5 L _5 L SI-'� L 5 w y I= YC W30 <br />/ <br />i JY l�40 kISJ XL N ( v, <br />PROJECT ADDRESS <br />qS'o 9 7_wll vc 5f= <br />APPI-ICANratITY BUSINESS LICENSE NO. <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 />_ <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK 3 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 />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />I CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM_ BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />_ _ <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL I <br />SUB TOTAL 3 <br />_ <br />PERMIT 3 <br />PERMIT <br />_ <br />TOTAL FEE $ <br />_S <br />TOTAL FEE 3 <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SLTBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USEZONE <br />Lot AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE CF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. OCO LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />1- <br />