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APPLICATION FOE% <br /> CITY OF <br /> TA[ElFrymn CONSTRUCTION <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ACOMBINATION ❑ BUILDING D MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNcA MAR ADDRESS CITY ZIP PHONE <br /> ,41,5x T St Cl>4i1; go; Al? ,svE w milirg-60 yaa75 353--007as- <br /> ARCHRECTOROESIONER MAIL ADDRESS CITY ZIP PHONE <br /> GE NERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> Dttl�'E-R _ <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> PLJMRING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> CLASS OF WON.. <br /> ❑ NEW ❑ ADDITION IN ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br /> VAL UATr/W;L WORN(CAST OF MATERIALS PLUS LABORI <br /> o„�Da <br /> DESCRIBE WORK "- <br /> C-oNuilcT LI !in-/P.n Me✓se lxjY( DLIPlE <br /> usE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> DUPLgx PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW FIR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL 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 /> T 77 26f D'P 0*. V NY LJSA/ A&C ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> Nt OR THE PERFORMANCE OF CONSTRUCTION. <br /> P�d6Ji . 7AE LJL rr {fie eT <br /> L. Xr SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> rf os of -5Nd I CTedJ 't 0 N. <br /> PROJECT ADDRESS APPLICANTS CITY BUSINESS LICENSE NO <br /> `l �d Yr Sri .S.E• -rt— <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIR COND,UNITS—H.P.EA _ <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> 1 LAVATORY WASH BASIN BOILERS-H.P.EA. <br /> I SHOWER OAS FIRED AC. UNITS—TONNAGE EA <br /> KITCHEN SINK&DISP. FORCED AIR SYSTEMS-0 T.U. MEA <br /> DISHWASHER WALL HEATERS—B.T.U. M <br /> LAUNDRYTRAY UNIT HEATERS—B.T.U. M <br /> IX CLOTHES WASHER EVAPORATIVE COOLERS <br /> ' _ CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN r RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. _ <br /> _ VACUUM BREAKERS STOVE <br /> POOF DRAINS—RAINLEADERS METAL FIREPLACE[CHIMNEY <br /> SINK SERVICE—BAR ETC. WOODS OVE/FIR LAC INSERT <br /> 7M I <br /> BUB TOTAL BUB TOTAL t <br /> r PERMIT i PERMIT { <br /> q TOTALFEE 81 TOTALFFE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN f yCH7E KNUMBER PLAN CHECK FEE <br /> < F•�1 / 'Qr�111 FEE�l RECEIPT NOX/iJCi�Z/ 1 <br /> USEZONE LOT AREA VACA T AE Il �J <br /> R f A JBTJ OYER O FE[{ VALUATION F[[ <br /> TYPEOF CONST OCCUPANCY GROUP NO OF GIVE LINO UNITS <br /> �- A/ 9 -3 Z BUILDING S <br /> SIZE lOO .j, NO Of STORIES MAK OCG.LOAD, PLUMBING <br /> 7 W /AY`A DO <br /> MECHANICAL <br /> FIRE SPRINKLERS REQUIRED D YES XNO <br /> OTHER 2sf 20 <br /> PENALTY <br /> APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE BY <br /> � L TOTAL __- <br /> Lv,e7� 7v !� ►-�a�p — <br />