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APPLICATION FOR. <br /> GryOF""" APPLICATION <br /> ZONSTRUCTION e <br /> everett PERMIT 19) <br /> BUILDINP bEPARTMEN 1 <br /> 259.8715 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMULITION U COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS CITY !IP PHONE <br /> f 1 -Le-0_4;9, ,. /4 <br /> O D-.=� 5/ 4 L In xA S O tt <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY !IP PHONE <br /> GFNEnAI GONIRACIOR <br /> MAIL ADOnESS CITY !IP PHONE LICENSE• <br /> a <br /> ,T.{/ I•C.:PL., ee�L-QBE- >-�,� 9 fr 1O_T-a S8 .11 714 J <br /> MECHANICAL CONTRACTMAIL AOORFSR CITY !IP PHONE IILENSE r <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY !IP PHONE IILE-NSE. <br /> CUSS OF WORK <br /> 9-NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUATION Of VIGAK ICOST Of MATERIALS PLUS LATIUM <br /> A4 6 O On <br /> DESCRIBE WORK ^ n � <br /> USE or BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> .�gCL PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCnIPI10 F PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONSOF LAWSAND ORDINANCES GOVE9NII IG THIS TYPE <br /> I A e J OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br /> LOT-31�v BLoc�—of IN OR NOT,THE GRANTING OF A PERMIT DOES'VOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THI: PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULAI IN(i CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OFCONIRACTOR OR AUTHORIZED AGENT DAIS. <br /> PROJECTADDRESS APPLI ANr CITYSUSMESS LIC EN EN <br /> i <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE Of FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND. UNITS-11.P EA. <br /> BATHTUB REFRIGERATION UNITS-HP.EA <br /> LAVATORY WASH BASIN) BOILERS-H.P.EA. _ <br /> SHOWER GAS FIRED AC.UNITS-TONNAGE EA <br /> _ KITCHEN SINK B DISP. FORCED AIR SYSTEMS-B.T.U. MEA. <br /> DISHWASHER WALL HEATERS-B.T.U._ M <br /> LAUNDRY TRAY _ UNIT HEATERS-B,T.U. M _ <br /> CLOTHES WASHER I I EVAPORATIVE COOLERS _ <br /> WATER HEATER CLOTHES DRYERS _ <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE B CHIMNEY <br /> SINN SERVICE-BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUB TOTAL SUBTOTAL I _ <br /> PERMIT f _ PERMIT E <br /> TOTALFEE E TOTALFEE I <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK YEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE- <br /> 241, <br /> 2d � !'/ ) FEE I�� ECEIVO. — <br /> USELONEQ 101 AREA VACAN�IE U O� `^r o a'�S]=y F/ <br /> /{ IZ d�d OYE9 O fIEB VALUATION FEE rl <br /> TYPE Orc=1 OCCUPANCYt'a ou NO OF DWELLING UNITS `FFV <br /> N M BUILDING S ���� 77- VU <br /> SNE Or BIDU NO Or STOGIES MAX OCC LOAD I <br /> X / PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED U YES O NO <br /> OTHER <br /> PENALTY <br /> APPI ICADON ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY -�- <br /> S�, TOTAL <br />