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IAeEvelatiin APPLICATION F01. P <br /> CITY OF CONSTRUCTION 0 <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 268.8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION O BUILDING 4TMECHANICAL O PLUMBING ❑ SIGN <br /> O,yryfp MAIL AD R653 CITY IIP PHONE <br /> )� /�— ( •/ <br /> FI �. 1 L) l )4_r_ !`IF E, fir. i rE . / 1 /$ .c•`'. _>' �-ckG 5 r� <br /> ARCHIrlicrop otenl ER MAIL ADDRESS city ZIP PHONE <br /> GENERAL CONTRACTOR MAR ADDRESS CITY tip PHONE LICINAI F <br /> MECNANK.AL CONIRACTOq rAll ADGRE S CITY �}lIP PINNE LK;l NSE F <br /> PLUMeINGCONfRACFOA MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> CLAPS OF WORK <br /> I� NEWADDITION ❑ ALTERATION [3REPAIR 13 DEMOLITION' ElWOODSTOVE/FRPL.INSERT 1:1BUILDING RELOCATION <br /> VAL VANGN 01 g.(COST Or MAIL MALS FLUE LAOTIAN <br /> 0l ECRIe!WORN <br /> /VCE✓ l <br /> USE OF BWIDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AI`- <br /> `f1 PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> LEGAL DEECRIPTONOr PROPERTY ISNOWN BELOW OR AT TACH FOUR COPIFRI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS I YPE <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 PROVISIOPIS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> / ) SIONATURE OF CONTRACTOR ORAUTHORIIEO AGENT GATE <br /> X � 1 L, <br /> PROJECT ADDRESS APPLI ANTSCIn BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE _ <br /> WATER CLOSET I TOILET) AIC—AIHNOLO UNITS—H P <br /> BATHTUB REFRIGERATION UNITS—H P EA <br /> LAVATORY[WASH BASIN) BOILERS—B T U MP _ <br /> SHOWER OAS FIRED A C.UNITS—0 T.U. <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.IU M _ <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL "7 CLOTHES DRYERS / � T•I\ <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN RANGE HOOD <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS—RAINLEADERS WOOD STOVE _ <br /> SINK(SERVICE—BAR ETC 1 7. METAL FIREPLACE E CHIMNEY <br /> FIREPLACE INSERT _ <br /> HEAT PUMP <br /> OAS PIPING _ <br /> EAHAUSTFAN <br /> SUE TOTAL E SUBTOTAL _ <br /> PERMIT P PERMIT <br /> TOTAL FEE t TOTALFEE <br /> (RUNT SF IBACr REARSEIBACK BIDE SETBACK RAN CHECK NUMBER FEE RECEIPT NO <br /> USE IONS LOT AREA VACANT BITE FEES VALUATION FEE <br /> DYES ONO <br /> BUILDING S <br /> TYPE OF CONST OCCUPANCY GROUP NO OF OVIFLLINO UNITS — <br /> PLUMBING _ <br /> SIZE Or BL DO NO Or STORIES MAR OCC LOAD MECHANICAL <br /> OTHER _ <br /> FIRE SPRINKLERS REQUIRED O YES O NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPIICATIONACC BY PLANSCHECREDBY Arrn ron ISSUANCE BY <br /> PUBLIC WORKS <br /> TOTAL <br /> PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />