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IMAPPLICATION F O k evereR <br /> CITY OF CONSTRUCTION <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING G MECHANICAL ❑ PLUMBING Cl SIGN <br /> OWNLA MAIL ADDHLSS CITY DP PHONE <br /> DoRyAnl C'-oN9,'2uP_j10jJg DEL)�r_UPnr i //Jc p0./3OX 4Jy74 Gauu/✓r"IA &v/ /?3 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS T CITY ZIP PHCNE <br /> NOR-Iak<i lipm( hc<,rA) 109D/ &y E"j lJr9V i IacojuA S fry/ 6?D�j <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> D0aYA/J DA)<ik'APTIU&) v DE✓eE DPn1 EATi 'P0 Pax gov7b /s"ccLc✓/� f)A Rbd Jy GL//-E 7e3 <br /> MECHANICAL CONTRACTOR NAIL ADDRESS CITY ZIP PHONE LICENSE A <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE • <br /> CLADS OF WORK <br /> f Q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK(COST OF MATER4L PLU9lARORI <br /> DESCRIBE WORK / <br /> Nem �KS�C/AL fiasn <br /> USE OF BUILDING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATIONAND KNOWTHE SAMETOBE TRUEANDCORRECT.ALL <br /> LEGAL DLRI WID1 PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES( PROVISIONS OF LAWSAND ORDUTANCES GOVERNING THIS TYPE <br /> / 0 OF WORK WILL BE COMPLETED WITH WHcTHER SPECIFIED HERE- <br /> IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PPOVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE F RMANCE OF CONSTRUCTION. <br /> SIGN TRACTOR OR AUTHORIZED AGENT DA <br /> X <br /> PNOIECTADDRESS Anel R1ANTq LITY BU NESS LICENSE NO / <br /> -7 / ,), A & <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ') AIC—A,HNDLG UNITS—HP <br /> BATHTUB REFRIGERATION UNITS—H P EA <br /> LAVATORY IWASH BASIN) 1 B0ILERS—STUMP <br /> SHOWER GAS FIRED AC UNITS—BTU <br /> KITCHEN SINK 6 OISP FORCED AIR SYSTEMS—B T U MEA <br /> DISHWASHER I ALL HEATERS—BTU M <br /> LAUNDRY TRAY UNIT HE/.TERS—B T U M <br /> rj_ CLOTHES WASHER EVAPOR/.TIVE COOLFRS <br /> URINAL CLOTHj.:i DRYERS <br /> DRINKING FOUNTAIN tj VENTILATIONFAN <br /> FLOOR DRAIN 2„ RANGE HOOD <br /> / BACKFLOW PREVENTERS WATER HEATER '7 <br /> ROOF DRAINS—RAINLEADERS WOOD STOVE <br /> SINK(SERVICE—BAR ETC I METAL FIREPLACE S CHIMNEY <br /> FIREPLACE INSERT <br /> MEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUBTOTAL ! SUBTOTAL I <br /> PERMIT S PERMIT <br /> TOTAL FEE S TOTAL FEE I <br /> (HUNT Sf TDA(•. REAR SE ABACK SIDE SEt BALK PLAN CHECK NUMBER FEE D7 RECEIPT NO <br /> z� 2 s / S-r 9709 baa - q54 <br /> USONE LOTAREA n VII SITE FEES VALUATION FEE <br /> 7 69 / S,h, AES ONO p �.I <br /> TYPE Or CO T OCCUPANCYGROUP NO OF DWELLING UNITS BUILDING <br /> (�t1 <br /> PLUMBING p {/ <br /> B2 -3 B8's SIF � NO OF STORIES MAX OCG LOAD MECHANICAL CI <br /> LOGNo4 <br /> Co zv SF 6.+R OTHER f I <br /> FIRE SPRINKLERS REQUIRED O YES 4O STATE BUILDING SURCHARGE •'a <br /> STATE ENERGY SURCHARGE <br /> APPIJCATION ACC BY PLANS CHECKED BY AFAR FOR ISSUANCE BY PUBLIC WORKS Z O ✓o <br /> TOTAL .S j <br /> r111 Fr` / PROPERTYOWNEHS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br /> I <br />