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TM,,,�,,, �.PPLICATION F0. We <br /> OF CONSTRUCTION <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION ❑COMBINATION BUILDING D MECHANICAL O PLUMBING ❑SIGN <br /> OWN�[�„ ��� MAIL ADDRESS CITY RP ZyC,L PHONE <br /> —z"" Af o (ubl4&,. 009Ji 9J A,- 16 lNo vier r L /wry sso 6 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> L.r1 .l.�S/sti, l7iS/SA�f cd. cflT 9eta-1 <br /> GENERAL UNIIMCIOH MAIL ADDRESS LrtV <br /> ' "ONE ( N/sCII[CEGNS�[ <br /> C.4,, 1-6- 71 <br /> 6,1",IV Ae., ZGL Mf-fSOF' u <br /> MECHANICAL CONTRACTOR MAN ADDRESS CITY ZIP PHONL LICFNSi <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PIIONF LICE NSL <br /> CLASS OF WORK <br /> lk NEW ❑ ADDITION ❑ ALTEPATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.IIISERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK(COST OF I.IATERMLS PAIS LABORI �—,% �1r1 <br /> • '•1YVI <br /> Of SCRIBE WORM <br /> USE LF eunDIRG�•J I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT.ALL <br /> LEGAL OMRIPTiON OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br /> r" l OFWORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT ! BLOCK--OF 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 /> 510NATUREOFCO RACRORAUTHORIZE ENT DATE <br /> X <br /> PROJECT ADDRESS APPLICAU FS CITY BUSINESS LICENSE NO <br /> ( opoe ,E3 58ri r ��.S�• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> L WATER CLOSET TOILE AIR COND.UNITS-H P.EA _ <br /> BATHTUB REFRIGERATION UNI•y-H P EA <br /> LAVATORY WASH BASIN) BOILERS-H P.FA. <br /> SHOWER GAS FIRED AT. UNITS-TONNAGE EA 1 <br /> KITCHEN SINK 6 DISP. .'ORCED AIR SYSTEMS-B T.U. MEA <br /> DISHWASHER WALL HEATERS-B.T.U. M <br /> LAUNDRYTRAY NIT HEATERS-B.T.U. M nJF - <br /> CLOTHES WASHER EVAPORATIVE COOLERS _ <br /> �j WATER HEATER CLOTHES DRYERS OQ <br /> URINAL VENTILATION FAN TOO_ <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- CFM <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE B CHIMNEY _ <br /> SINK ISERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT co__ <br /> BUS TOTAL SUBTOTAL t CO <br /> PERMIT S PERMIT t _ <br /> TOTAL FEE $ 4 TOTAL FEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PUN CHECK NUMBER PLAN CHECK FEE <br /> -2-0 <br /> -0 Zeq—T w FBI FEE RECEIPT NO <br /> USE ZONE LOT AREA VACANT SITE <br /> F![t VALUATION F[[ <br /> 2_2 (JaS ONO <br /> TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> -m-Ad 12-3 2 BUILDING ` b CQ <br /> SIZL OI BLDG NO OF STOBIEs MAK DCC LOAD <br /> J'1 PLUMBING <br /> Qm <br /> MECHANICAL [ c_ <br /> FIRE SPRINKLERS REQUIRED ❑YES ONO <br /> OTHER <br /> PENALTY <br /> APPLICATIONACC BY PLANSCHECKED BY APPR FOR ISSUANCE BY --' <br /> TOTAL <br /> s� S� �c•�L_-� c� fIA� ��l <br />