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APPLICATION FOK <br /> IAT "" CONSTRUCTION <br /> CI"T'TY OF DF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION I7 COMBINATION IJ BUILDING I I MECHANICAL ❑ PLUMBING ❑SIGN <br /> :Ir rlln YON <br /> 69 ' 799 <br /> ARCHITECTOR DISGNIN " 1 M•II •ODIIL BS .\111F—]^Lll city III lll' 1410N <br /> GENERAL CONTRACTOR MAIL ADDRESS f.11Y INIONF HCL NRL A <br /> MECHANIC.-.CONTRACTOR MALI ADDRESS T.ITY liP PHONE LICE IIS[ h <br /> a�� ISL <br /> PLUMDINR CONTRAL T(IO MMI ADDOE SS LILY lN• '40"41 UL1115L <br /> CLASS OF WORN ' <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION— <br /> VALUATION OF WORK jCOST Or MATERIALS PLUS LABORI <br /> j DFSCRIBE won <br /> N _ <br /> USE OF BUR DING , A I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> LEGAL DESCRIPTION OFPROPERTY UPIOWNDELOW ..........orouncotiiss PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br /> LOT_BLOCN__Or IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUIII F ITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ' AN 7HER fff���TE ORLOCAL LAW REGULATING CONSTRUCTION <br /> i' OR I 1 t_ I )'IMANCE OF CONSTRUCTION. <br /> j Sn.NA a I I I OACTOR OR AUTHORIZEOAGLNT DATE <br /> PROJECT ADDRESS •FPIIGN SIah NlcaNI SSHICINSC NO <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ArC-AIHNDLG UNITS-H P <br /> BATHTUB REFRIGERATION UNITS-HP EA <br /> LAVATORY IINASH BASINI BOILERS--B T U/H P <br /> OAS FIRED AC UNITS-BTU <br /> SHOWER <br /> KITCHEN SINK 6 DISP FORCED AIR SYSTEMS-8 T U MEA <br /> DISHWASHER WALL HEATERS-BTU M <br /> LAUNDRY TPAY UNIT HEATERS-B T U M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL CLOTHES ORYERS <br /> URINAL FOUNTAIN VENTILATION FAN <br /> RANGE MOOD <br /> FLOOR DRAIN <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS-RAINLEADERS WOOD STOVE <br /> SINN(SERVICE -BAR ETC) <br /> 77 <br /> or METAL.FIREPLACE S CHIMNEY <br /> f INEI'IACE INSERT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUST FAN <br /> SUBTOTAL f <br /> SUB TOTAL <br /> PERMIT { PERMIT <br /> TOTAL FEE ! TOTAL FEE <br /> _ - PLAN CHECK NUMBER FEE RECEIPT NO <br /> I-MINT SE_TBACA --- -_ RI•rI SIDE SETBACK <br /> USE ZONE LOT AREA VACANT SUL FEES VALUATION FEE <br /> I UYES IINO 5 <br /> BUILDING <br /> TYPE Or CONST OCCUPANCY GROUP NO Or DWELLING UNITS <br /> PLUMBING <br /> SIZE OF BE 00 NO OF STORIES MAX OCC LOAD MECHANICAL <br /> OTHER <br /> FIRE SPRINKLERS REQUIRED U YES D NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPLICATION ACC BY PLANSCHECNED BY APPA FOR ISSUANCE BY PURLIGWORKS <br /> TOTAL <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL �I <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />