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�.{PPLICATION FOit' <br />CITY or CIT "B CONSTRUCTION " <br />OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK• PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION a BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />ounit n � MAIL ADDRESS CI % 1•P IA..ILI i� i PNOn <br />�/_ _i cv , <br />GENERAL CONTRACTOR MAIL ADDRESS bTY ZIP PIIONF LICENSE <br />A. T I._ /') I / L I __ - _ -_ I <br />PLUMBNIRCONIPACIOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />YALUATIONOF WnR. COST OF MATERIALS PLUS LABOR, I I <br />LEUAt DF5CnIPI101I OF PROPEBTYISNOWN BELOW OR ATTACH ICIIR COPIES, <br />LOI_BLOCII <br />PROIFCT ADDRESS <br />I HEREBY CERTIFY I HAT I HAVE READ AND EXAMINED TIiIS A;� <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 UOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X '-2e,4 D 0 O <br />APPLwANrS CITY <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I TOILE TI <br />AIC - AMNOLO UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS - B.T.0 IH P. <br />SHOWER <br />OAS FIRED A C. UNITS - S.T U, <br />�- <br />KITCHEN SINK A OISP <br />_ <br />FORCED AIR SYSTEMS - B T U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS - BTU M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKINC FOUNTAIN <br />VENTII ATION FAN <br />FLOOR GRAIN <br />11ANGE HOOD <br />DACKFLOW PREVENT ERS <br />WA TER HEATER <br />ROOF DRAINS - RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE - BAR ETC I <br />FEETAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />OAS PIP'NO <br />EXHAUSTFAN <br />SUBTOTAL <br />E <br />SUBTOTAL <br />PERMIT <br />I <br />PERMIT <br />TOTAL FEE <br />1 <br />TOTAL FEE <br />T POST Sf TBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />RFARSETUACN <br />SIDE 9O BACK <br />USE 11111E <br />LOT AREA <br />DYESVACANT SITE <br />ONO <br />OrE9 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />101 OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PI. UMBING <br />SMT OF 11100 <br />NO OI STORIES <br />MAN OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REOUIRED O YES O NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />AIPHCATIONACC BY <br />1PLA04CHIECKEDISY <br />APpn FOD ISSLMNCF BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENIS <br />