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the Everam R <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8745 <br />.-UPPLICATION F0h%J <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNfR MAIL AODRES. CITY ZIP PHONE <br />Cal' !. i7Ac'i/t'Fit'c R sl< !/st— &Nr.•".CITt y�t13 3 1 •�r7 <br />ARI;t",Lc I OR of STONE R MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY SIP PHONE LICENSE• <br />MECHANICAL CONIRACInn MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PIOMBINOCONIRACTOR MAIL ADDRESS CITY ZIP MIONE LICENSE• <br />.SE'LIT/I CE'1. PlCIYS. 19rly�o� k%_ E4qAIIA;0j 4'As)y :dp4Y :).�'ldJ7 Srl•;MeI' iYi'z <br />['LASS Of WORX <br />❑ NEW ® ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTO'/EIFRPL.INSERT ❑ BUILDING RELOCATION <br />VAI UUAHON OF W HIK ICOST OF MAIERIALS INUS LABORI <br />3rcr. <br />of SCRIBE WUDK <br />� I <br />/;a.�/. <br />USE OI RUIIUING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOLS NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT JDATE <br />X / <br />�7E .E rl'" M • Vvsi CAL N �'-2. <br />LCUAL UESCRIPTBFN OF PPOPERTI'ISHOWN BELOWORAITACH FGURCOPIEFI <br />e",*17 t, /) 1 %', � <br />LDI�BLGCK� OF_ILC <br />PROJECT ADDRESS <br />APPI. ICANFS CITY BUSINESS LICENSE NO _ y <br />PLUMBING <br />MECHANICAL <br />NO. <br />_ _ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT _ <br />_ <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS -HP EA. <br />I <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY WASH BASIN) <br />CW <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS-8 T U M EA <br />_ <br />_ <br />DISHWASHER <br />WALL HEATERS-0 I. U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_- <br />CLOTIIES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />VACUUM RREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK(SERVICE-BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />BUS TOTAL <br />BUS TOTAL IT <br />PERMIT A <br />PERMIT A <br />TOTALFEE A <br />_ <br />TOTALFEE A <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />'AUNT Sf IDAEA <br />/ <br />NIAII SETBI,,X <br />I <br />_J <br />SIDE SETBACK <br />Jam/ <br />PLAN CHECK NUMBER <br />(�//��Ut1G <br />O LP <br />PLAN <br />fEELA S�% <br />CHECK FEE <br />RECEII9N0�� <br />USE ZONE <br />flI - `Jv <br />LOT AREA <br />VACANT SITE <br />OYES 0 <br />FEES <br />VALUATION <br />VALUATION <br />[E[ <br />�L11 11d <br />( / _ <br />IIt E LSIP 3L/A14c <br />� <br />1F�r_ <br />_ 1..7_o- <br />CIII <br />J -'- <br />vc) <br />IYI.I W CONSI <br />U(u <br />01ILUPANCV GROUP <br />p - -,7 <br />V <br />NO OF DWELLING UNITS <br />I <br />BUILDING <br />$ <br />SIZE Of BI UO <br />-.Jr <br />•J <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED U YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />AVPMGIION A[f. BY <br />IAA /� <br />PL AN9 CnELKEO BY__ �APPR <br />=�,; <br />FOR ISSUANCE BY <br />L G <br />TOTAL <br />— <br />