1909 16TH ST 2018-01-02 MF Import

, XPEICATION FOk. OF C EYergrwn CONSTRUCTION cln everett PERMIT BUILDING DEPARTMENT 259.8810 TO BE COMPLETED IN INK• PLEASE PRINT ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 54 MECHANICAL ❑ PLUMBING nwurR NC K- ..... ... ....,... will'12vn /LOss,�o.lt biz . Qfao VTR-J3v9 OR MAIL ADDRESS evcrPN ❑ SIGN 01.ILLIUL LUNINACIOR MAIL AIJORLBB CRY LIP I'IIUNI LICLNyL - liw MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• PLUMBING CON TRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• CLASSOF WORM. ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION: VALUAT-014OF WORK #COST OF MATERIALS PLUS LABOR, DESCRIBE WORK , }`�Cl.r w -AA "i1Y„ u�' - �' ter. — 'U." IA,SCL: u.-.c-L:.. I�TeLp•tlSus USE DI BUILDING Q' �A /nr I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP-. PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS I YPE OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE, IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO" GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE Or CONTRACTOR OR AUTHORIZED AGENT DATE LLOµ OESCRIPIIDII OF PROPERTY ,SHOWN BELOW ON AI IAC,1 LOUR LOPIf:51 LOI_BLOCK_OF PROJECT ADDRESS �1 e�l/`P.-r>r'P.iT�I ? APPLICANT'S CITY B SINESS LICENSE NO PLUMBING MECHANICAL NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE WATER CLOSET (TOILET) A/C — AIHNOLG UNITS — H.P. BATHTUB REFRIGERATION UNITS —H.P EA. _ LAVATORY 1 WASH BASIN) BOILERS — 8. T.0 /H.P. SHOWER GAS FIRED A.C. UNITS — B.T.U. KITCHEN SINK A DISP FORCE? AIR SYSTEMS —B.T.U. M EA. DISHWASHER WALL HEATERS—B.T.U. M LAUNDRY TRAY UNIT HEATERS—B.T.U. M CLOTHES WASHER EVAPORATIVE COOLERS URINAL CLOTHES DRYERS _ DRINKING FOUNTAIN VENTILATION FAN FLOOR DRAIN RANGEHOOD BACKFLOW PREVENTERS WATER HEATER ROOF DRAINS — RAINLEADERS WOOD STOVE SINK (SERVICE — BAR. ETC I METAL FIREPLACE 8 CHIMNEY FIREPLACE INSERT HEAT PUMP GAS PIPING EXHAUSTFAN SUBTOTAL f SUBTOTAL �r PERMIT f PERMIT TOTAL FEE S TOTALFEE IRONT SETBeC; PLAN CHECK NUMBER FEE RECEIPT NO. REAR SETBACK SIDE SETBACK USE ZONE LOT AREA VACANT SITE OYES ONO FEES VALUATION FEE BUILDING S TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS PLUMBING SIZE OF BIDS NO OF STORIES MAX OCC. LOAD MECHANICAL OTHER FIRE SPRINKLERS REQUIRED O YES D NO STATE BUILDING SURCHARGE STATE ENERGY SURCHARGE APPOCAHONACr BY PLANSCHECKED BY APPR FOR ISSUANCE BY PU8110 WORKS TOTAL PHV YtHIY Vvvrvtno Hnc nlawlwmw rvn vcu,nu .n.., ..�� PROPERTY LINE LOCATIONS AND RELATED EASEMENTS.