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r <br /> APPLICATION FW PYPTE„ <br /> cnCIT``r OF CONSTRUCTION <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK-- PLEASE PRINT <br /> BUILDING DEPT. <br /> 259.8745 ❑ COMBINATION It BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWKER MAIL ADDRESS CITY ZIP PHONE <br /> .T'd Z C+ L1Svv X15 (o o �.Ve/QTT wit 9SZo '3 3.3V, '3 <br /> AS6HHEC10RDESIGNER MAIL AGGRESS WIT' IIP F� / PHONE <br /> L1)A 'DSUIL �,LCiF3/ dCl$' Qi�' 5W �yg#yCULdD �JGFrjp 71 37S 7 <br /> GENERAL COMIOACIOS MAIL ADORE95 CITU 21P PHONE LICENSE <br /> ►�Il� SLJ �YUSL C'.ts� ��'3/ 3c8a ( S4! 44Nlkreu `I�36 77 <br /> MECHANICAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE Iu(muNt"',Ssrr D, <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br /> CLASS OF WORK <br /> ❑ NEW % ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> 2 <br /> VALUATION OF WORK ICOST OF MATERIALS PLUS LARORI Oy <br /> f o/ 6 0 L:1 .. <br /> DLSCRIBE( 7ORK m clot I$,G „ X �41U11 �ec ��oy �TT1 <br /> us r BUILDING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br /> USE <br /> P• <br /> -1 n <br /> PS / DK' S C PLICATION AND KNOW THE SAME TO BE TRUE AN D CORRECT.ALL by <br /> LEGAL DEBCRIPIION OF PROPERTY ISHOWN BE LOW OR ATTACH FOUR C.OPIE91 PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE Lnm <br /> 0�eLocK_er <br /> O00 W P 5 / IO •? Ff. F OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE-Lor — INOR NOT.THEGRANTINGOFA PERMITDOES NOTPRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK m o <br /> E r 6 r c a - V OR THEANY HER STATE OR LOCAL LAW PERFORMANCE OF CONSTRUCTIONNG CONSTRUCTION c F <br /> 'e Tr t / SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE -F Z <br /> X Ao <br /> PROJECT ADOPT$9 APPLICANT-'ar Y BUSINESS LICENSE NO ~ <br /> w I=i <br /> 3,, -4- <br /> r -4- <br /> PLUMBING MECHANICAL _ _.— '+T <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSETTOILE AIR COND. UNITS-H.P.EA <br /> BATHTUB REFRIGERATION UNITS-H.P.EA _ FIT I- <br /> _ LAVATORY WASH BASINT BORERS-H.P.EA _ <br /> SHOWER OAS FIRED AC.UNITS-TONNAGE EA EO'T m <br /> KITCHEN BINKB DISP. FORCED AIR SYSTEMS-B.T.U. MEA 3 V)a N <br /> DISHWASHER WALL HEATERS-B.T.U. M Nc m <br /> LAUNDRY TRAY UNIT HEATERS-BT.U. M '-Ir- <br /> CLOTHES WASHER EVAPORATIVE COOLERS A <br /> _ WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. --I <br /> VACUUM BREAKERS STOVE H <br /> ROOF DRAINS-RAINLEADERSMETAL FIREPLACE B CHIMNEY N <br /> BINK SERVICE-BAR,ETC WOODSTOVE/FIREPLACE INSERT _ Z <br /> O <br /> y <br /> ♦.I <br /> n <br /> I'm <br /> SUBTOTAL _ SUBTOTAL ! <br /> PERMIT ! PERMIT ! <br /> _ TOTAL FEE B _ TOTAL FEE_ ! <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK NiAR 9E1RAGK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> NA • FEE !� SEC <br /> USE ZONE r LOT AREA'/ VACANT BITE FEES VALUATION FEF. <br /> /�-Z 14 Lit 0 DYES TFNO <br /> TYPE OF CONST _ OCCUPANCY GROUP NO.OF DV�LINO UNITS SUIl01N0 i <br /> SIZE OF BLDG. NO OF STORIES MAX.OCC.LOAD <br /> /Y1�/U •F qW ,�Y/ / •� PLUMBING — <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED D YES AND 0114ER <br /> PENALTY <br /> APPLICATION ACC.BY PLANS CHECKED IY APPR FORISBUANCE BY <br /> TOTAL <br /> Jf'G <br />