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APPLICATION FOK Ed] <br /> CITCITY OF EOF CONSTRUCTION <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> OWNER MAI)ADDRESS CITY ZIP PHONE <br /> �s PN PI gr7E/o� �loar I-) /+071 f/o s/�,(/E <br /> Y�6L�(J� �arn.•./ a rPrf..i 73'b"/ <br /> ARCIuI(Cl OP DI SIUNI II MAIL AOORESS 'Y !IP PHONE <br /> �lorT�iiiiEZ -- (�ff�D,QHAA/13DP <br /> .EN IAl CONIRACIOP AR ADORFSS Glv SIP PHONE UG•P1f <br /> MEGSANNICALC NTRAC.TnH MAIL ADDRESS TTY ZIP PHON• LICENA <br /> PLIIMBINr, 0kI MAIL ADDRESS QITY ZIP PH)NE LICLNSE • <br /> CLASSS I WORK <br /> 0" NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VAIU(nON OF WORK)COST OE MAI,RU SPLUSLABOR- <br /> �. 5:' Oab _ - -- <br /> DESCRIBE W'IIRK <br /> 7� <br /> C�apJ /IuCZt Q "A to True USE of Bulk DIN, 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED -i HIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> LEGAL nES[plptlpq OF PROP RTYISHOWN/1CLL:WOR A,IAO1 FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCESGOVERIJING 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 OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CON STF.UCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> r <br /> SIGNATURE OF CONTRACTOR HORIZED AGENT DATE <br /> i <br /> PROJECT ADDRESS APP) CITY BuSINF;S Of.EN.l NO /���JL / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) - ASC -AMNOLG UNITS-H P <br /> BATHTUB - REFRIGERATION UNITS-H P EA <br /> LAVATORY IWASII BASIN) - BOILERS-B T U,H P <br /> SHO NER GAS FIRED AC UNITS-BTU <br /> KITCHEN SINK 6 OISP _ FORCED AIR SYSTEMS-B T U M EA <br /> DISHWASHER WALL HEATERS-BT.U. M <br /> LAUNDRY TRAY UNIT HEATERS-WT U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> URINAL R CLOTHES DRYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN RANGE HOOD a <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS-RAINLEADERS WOOD STOVE <br /> SINK(SERVICE-BAR.ETC I METAL FIREPLACE 6 CHIMNEY <br /> FIREPLACE INSERT <br /> HEAT DUMP <br /> GAS PIPING <br /> EKHAUSTFAN <br /> SUB TOTAL f -- SUBTOTAL <br /> PERMIT f PERMIT <br /> TOTAL FEE f TOTAL FEE <br /> PLAN CHECK NUMBER FEE' RECEIPT NO. <br /> FBONI SETBAC REAR SETBACK SIDE SETBACK � ��6 �3 <br /> Ze 64DI0 te' io• *- 6' _ X Z o oG LX 9 s ' <br /> USE ION LOT AREA L� VACANT SITL FEES VALUATION FEE <br /> 'k�Z �'' T UNO s yy <br /> BUILDING <br /> TYPE OF CONST OCCUPANCY CROUP O OF DWELLING UNITS <br /> _ 11 / 7- -L PLUMBING ton <br /> SIZE OF BLOU 1114 <br /> NO OF STORIES MAX OCC LOAD MECHANICAL <br /> go Z- FIf <br /> OTHER )-475 <br /> FIRE SPRINKLERS REOUMED D YES O STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE w <br /> APPLICATION ACC BY PLANS CHECKED BY IPPR FOR ISSUANCE BY PUBLICWORKS u r <br /> TOTAL /�� <br /> III <br /> TVA Q„V C• PROPERTY LIDETERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />