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DV <br /> IA.EYFIETEPP ''i ' PPLICATION EO`„1 'u �, �- EYEFER <br /> CITY OF CONSTRUCTION f O. "1 <br /> everett PERMIT <br /> 259881NG 45 DEPARTMENT TO BE COMPLETED IN INK - PLEASE PRINT <br /> O DEMOLITION ❑COMBINATION L BUILDING O MECHANICAL O PLUMBING ❑SIGN <br /> OWNER MAIL ADOPEBS CITY ZIP PHONE <br /> FtreE5 ?P. 63 3sS 89� <br /> AOpllECTOn OTNER MMLA,7,EBB J p xft ZIP PHONE <br /> (IV , Tatty Ido eo"C, r J o L9 n�Mx;/�t7� � u,� �st7y• R45,sec C 154 KM • <br /> 2w RAL CONTRACTOR MAILADOnEBB CITY ZIP PHONE LICENSE If <br /> MEOHANICALCONTRACTOR MAIL ADDRESS Curr ZIP PHONE LICENSE• <br /> PLUMSINOCONIRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE- <br /> CLASS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUATION Or WORK(COST Or MATE RIAI S PLUS LABOR <br /> OESCRISF WOnK <br /> USE OF euILDIrIG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PV ! bx PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION Or PnOPERTY 15HUWN BELOW OR ATTACH FOUR COMEBI PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OA CANCEL THE PROVISIONS OF <br /> -77 62' Ln t l ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> fmt11/0,14,L nel:T SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> PRIJECTADDRESS ARBOCANracayllusiISS LICENSE NO S <br /> 4”4 000d <br /> PLUMBING MCCHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND UNITS—ILP.EA _ <br /> BATHTUB REFRIGERATION UNITS-1/P. EA <br /> LAVATORY WASH BASIN) BOILERS—H.P.EA. <br /> 8140WER OAS FIRED AC. UNITS—TONNAGE EA <br /> KITCHEN SINK 6 DISP. FORCED AIR SYSTEMS—B.T.U. M EA. <br /> DISHWASHER WALL HEATERS—B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHER 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 _ ET E A CHIMNEY <br /> SR11SERVICE—BAA,EIC. WOODSTOVE/FIA LACE INSERT <br /> BUB TOTAL SUBTOTAL A <br /> PERMIT E _ PERMIT E <br /> TOTAL FEE E TOTAL FEE E <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> PONT SETBACK REARSEHIACK BIDE BE HUCK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO <br /> ISE TONE LOT AREA VACANT SITE <br /> OYES ONO FEES VALUATION FEE <br /> YPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> BUILDING E <br /> IZE OF SLOG NO OF SIODIES MAX OCC LOAD <br /> PLUMBING <br /> MECHANICAL <br /> -IRE SPRINKLERS REQUIRED O YES O NO <br /> OTHER <br /> PENALTY <br /> IPPLICAHON ACC. BY PLANSCHICKED BY APPR ron ISSUANCE BY <br /> TOTAL 1 <br /> C <br />