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IR.E..1{ `APPLICATION FOR PYPTBB <br /> CRT OF CONSTRUCTION <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEASE FRINT <br /> BUILDING DEPT. <br /> 259.8745 ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> p AIL ADDRESS CITV ZIP NIONE 79 <br /> M2�Ll P�'U�C�. r�/arl.9. /l 1;pl4,,e1w e ,^d'7-3 <br /> ARCHITECT C&EINGIVER MAIL ADDRESS CIN ZIP KION - G� I <br /> fT)AR)m 4 (11�U/ MAIL ADD410 bRESSITY TIP PH,OyN/ESL LICENSE:• <br /> MECHANICAL CQNTRACTORI MNL ADDRESS ciTYKnV ZIP I"ONE LICENSE <br /> PLUMBING CONTRACTOR MAILADDRESS CIN ZIP PRONE LICENSE <br /> A <br /> CILmis OF w RIK <br /> y! NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br /> V LUATION OF WORKIOOST OF IAATERDPAJIPLUS LADORI <br /> %r 7 &coo• o a <br /> DE{CAUt WORK <br /> USE BU DI E U I HEREBY CERTIF"THAT I HAVE READ AND EXAMINED THIS AP- <br /> 1 PLICATION AND KT OW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DEStRIPTIOWOF PROPERTYISHOWNBELOW OR ATTACH ou covLEsr PROVISIONS OF LAWS AND ORDINANCES GOVER NI NG THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> LOTIBLOCN_C, �I11! / INORNOT.THE GRANTINGOFAPERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL fHE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR Inc PERFOCONRMANOR CE OF ONSTRUCTION. ! v 7 <br /> SIGN TUREOFTRACTORAD ORIZED AGENT DATE �7 <br /> X_7lU��' �rJiC� <br /> PROJECT ADDRESS APPLICANTS CIN BUSINE LICENSE NO <br /> PLUMBING MECHANICAL <br /> N TYPE OF FIXTURE FEE NO. TYPROF SOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND.UNItS-I18—H.P.EA <br /> BATHTUB Rii REFRIGERATION UNITB_H:P.EA <br /> LAVATORY WASH BASIN BOILERS—H.P.LA <br /> SHOWER GAS FIRED A.C.UNITS—TCNNAGE EA _ <br /> KITCHEN SINK{DISP. FORCED AIR FYSTEMS—B T.U. M F.A <br /> DISHWASHER 41L OO WALL HEATERS-B.T.U. M _ <br /> LAUNDRY TRAY _ CT7 UNIT HEATERS-B.T.U. M <br /> CLOTHESWASHER _ OD EVAPORATIVE COOLERS <br /> WATER HEATER CLOillE9 DRYER9 _ __ <br /> VENTILt TION FAN r. <br /> D RANGE HOOD <br /> FLCORORAIN AIR HANDLING UNIT- CF.M. <br /> VRCVUM-TREAWER9 40'MINg <br /> 1410- ROOF DRAINS-RAINLEADERS METAL FIREPLACE E CHIMNEY <br /> S4111C. WOODSTOVE/FIREPLACE INSERT <br /> Iti A- <br /> _ <br /> - NF <br /> SUBTOTAL SUBTOTAL • <br /> PERMIT { PERMIT { . <br /> TOTAL FEE { TOTAL FEE • - <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL : <br /> FRONT BE TBACK REARSEIBACK NDE SETBACK PLAN CHINUMBER PLAN CHECK FEE 10 <br /> TEE EIS' RECFIPI N G" <br /> USEZONE LOT AREA VACANT NIE FE{{ VALUATION FEE <br /> OYES ONO <br /> TYPE OF CONST. DOCUPANCYGROUP NO.OF DWELLING UNII9 O ' <br /> 2 BUILDING { 3(Y7 <br /> ,g0'�'9LQq <br /> Ml 22 s•K NO,Of STORIES MAX OCQC.LOAD . <br /> s a (e S F 2 1 PLUMBING on <br /> MECHANICAL _ <br /> FIRE SPRINKLERS REQUIRED ❑ YES SENO <br /> OTHER <br /> t <br /> PENALTY <br /> E <br /> APPLICAVONACC.BY PLANSCNLCKED S� APPH T OR ISBI'ANCE B+ <br /> TOTAL �� T I <br /> J <br /> r <br /> e <br />