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',•.PPLICATION FO�EI•' Flrrrll <br /> City or CONSTRUCTION <br /> CONSTRUCTION <br /> LITY DF <br /> everett PERMIT <br /> BUILDING DEPARTMLNT <br /> 259.8745 TO BE COMPLETEU IN INK• PLEASE PRINT <br /> O DEMOLITION J COMBINATION Jff BUILOINU O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> UWIIfn� MAI)ADORE/3Q/8(I ?I, <br /> ) �J CITY ZIP PHONE <br /> /•C��/.'IA.'!.'1 /Lii//,'r i'.s. ,�) /.CLW 1, JLI.L.ICr Ltt' I�L7Z / /�'.5,5✓f'� <br /> AIICIulI G1 OR OI SKINLR /t MAIL ADDRESS CITY ZIP PHONE <br /> UWEPRTLONIRACIOtI • MMUDORESS CITY /� IIP PHONE LICENSE• <br /> /. -L ��f'�.S.f✓L. <br /> MICIIANICAL CONTRACTOR MAIL ADDRESS 91" ZIP PHONE LICENSE• <br /> PLUMBMNCONtRACTOR MAIL ADDRESS city ZIP PHONE LICENSE <br /> CL ASS OI WORK <br /> J2 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALLIAIIONOr WORKICOSI Of MAIFn1AI SMUSLABOM M+ <br /> X11 _.�'�. G.I�J ✓`^�` �/ <br /> UI SCRIBE WORK <br /> arc,. (;,,L:�7/rA.L•.%/E-•:. <br /> usf OF BUiI HIND <br /> 1 HEREBY CERTIFY THAT I H! ;E READ AND EXAMINED THIS AP• <br /> d/ PI ICATI0NANOKNFIWTIIFSAMF TEIOF i urANf10E1RRFC1 All <br /> . .. <br /> IIIIAI UI!A.IUVININ H11.1 I'1IIh r11111Wll OIIOW TIN AIIAbIIl W11 LUI'IIHI PHOVISIUNSUF LAWS AND UHUINANCES UUVEHNING THIS TYPE <br /> S/1 _ OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> IOI-!`alLxla_or—� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> j C L F� I S ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION, <br /> SIGNATURE OF CON TRACTOR OR <br /> AUTHORIZED AGENT DATE <br /> X <br /> PAOJECI ADORERS APPLICANTS City BUSINESS LICENSE NO <br /> C,L4 N45 �� BTL, R <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> 41 WATER CLOSET TOILER AIR GOND.UNITS-H.P.EA <br /> _ L BATHTUB CD REFRIGERATION UNITS-H.P.EA <br /> E LAVATORY IWASH BASIN) ab BOILERS-H.P.EA <br /> SHOWER GAS FIRED AC.UNITS-TONNAGE EA <br /> Z KITCHEN SINK L OISP _ _ FORCED AIR SYSTEMS-S.T.U. MEA <br /> _ L DISHWASHEG _ CD WALL HEATERS-B,T.U. M <br /> _ LAUNORYTRAY _ Ltf UNITHEATERS-B.T.U. M [QA •�' ___ <br /> CLOTHES WASHER ef.en 2 EVAPORATIVE COOLERS _ <br /> WATER HEATER CLOTHES DRYERS q UO <br /> URINAL VENTILATION FAN W_ <br /> _ DRINKING FOUNTAIN RE - -HOOD _ _Q_ <br /> FLOOR DRAIN AIR HANDLING UNIT- CT M <br /> VACUUM BREAKERS _ STOVE _ <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACES CHIMNEY <br /> SINN SERVICE-BAR.ETC. WOODStOVVFIREPLACE INSERT <br /> tua 4 vo_ <br /> SUB TOTAL _ 3 SUBTOTAL E IC 6 66-- <br /> PERMIT <br /> -PERMIT B PERMIT 1 <br /> TOTAL FEE B TOTAL FEE E 00 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> I RANI sf)BACK BEAN SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK r[E. <br /> .:)G)r _90 • L FEE RECEIPT NO <br /> USI 1004E LOT AREA <br /> VACANT SITE FEES VALUATION FEE <br /> .� VIES ONO •� -- <br /> tYl•E OI CPT OCCIIPANCYGqRROUP NO OF CA ELLIND UNITS <br /> 1 - �' - •J oZ BUILDING E�CL>Lcp•Q.7 3'13 oa <br /> KNE UI Ill uuc NO Or STORIES MAX OCC LOAD -- <br /> _� PLUMBING 32_ (,o <br /> MECHANICAL <br /> FIRE SPRINKLERS REQUIRED U YES 0 NO <br /> OTHER <br /> _ PENALTY <br /> API'IICAIIONACG DY PLANSCIIECKEDBY APPR TOIL ISSUANCE By <br /> TOTAL _ <br /> ��LS(C Cry K <br />