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The EYPEpTNn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />AF­.r'PLICATION FOk <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />L> �353-9728 <br />ARCHITECT OR &SIGNER <br />/T MAIL ADDRESS <br />CITY <br />TN• <br />PHONE <br />II <br />U <br />GLNERAL CONTRACTOR <br />MAN ADDnESS <br />CITY <br />TIP <br />NOW <br />uC.NSE F <br />I I ��M_ I� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP <br />PHONE <br />ULENSE. <br />11 <br />T4 JMBINOCONTRACTOR <br />MAII ADDRESS <br />CITY <br />TIP <br />PHONE <br />LICENSE <br />11 <br />L1A95 O! WORN <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR ❑ <br />DEMOLITION ElWOODSTOVElFRPL. <br />INSERT ❑ <br />BUILDING RELOCATION <br />VALUATION OF WORK COST OF MATERIAL5 PLUS LAB RI <br />w <br />USE OF BUILDING u <br />.�, n1, <br />Ly��5fi <br />I H EBV 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 DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYO 11ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />SI�1 /,3 /rJ•O <br />LEGAL DESCRIPTION PROPERTY ISHOWN BELOW AITACII POURCDPILSI <br />LOT-5—BLOt DF r W S <br />�IU1 rJ1OYl * 2 <br />PROJECT ADDRESS <br />_ 03 <br />APPL .ANT. CRT BUSNLSS UCL`IISE NO <br />— <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 (TOILET) <br />♦IC - AJHNDLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - H P EA <br />LAVATORY WASH BASIN) <br />BOILERS - B.T U IH P <br />SHOWER <br />GAS FIRED A C UNITS - B T U <br />KITCHEN SINK B DISP <br />FORCED AIR SYSTEMS - B T U M EA <br />DISHWASHER <br />WALL HEATERS - B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS - D T U M <br />CLOTHES WASHER <br />I <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />_ <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK ISERVICE - OAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL i <br />j <br />SUB TOTAL <br />PERMIT S <br />PERMIT <br />TOTAL FEE 31 <br />TOTAL FEE <br />(RUNT SEIDACK <br />Zo <br />PLAN CHECK NUMRER <br />$� r 9 9 17 <br />FEE 65 <br />5 a -- <br />RECEIPT NO <br />c17 850 <br />RFAR SETBACK <br />?� <br />SIDE SETBACK <br />S " <br />USEZONE <br />K- � <br />LOTAREA <br />%GOO <br />YACMlT ❑L <br />OYE G <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE DL .WNST <br />-Y.L— <br />OCCUPANCYGROUP <br />Af —/ <br />NO OF DWELLING UNITS <br />'uf- <br />PLUMBING <br />SIZE OF OLD <br />�z76 o6AO.P <br />NO OE STORIES <br />/ <br />MAA 0CC LOAD <br />N �/ <br />/'I <br />MECHANICAL <br />OTHER <br />f, f 4 4 C4R %?OA@'T <br />FIRE SPRINKLERS REQUIRED u YES JeNO <br />STATE BUILDING SURCHARGE <br />?j <br />STATE ENERGY SURCHARGE <br />WR'I LI TION ACC BY <br />T/� � <br />IF, IF <br />PLANSCHECKED BY <br />/{� <br />��C_ <br />APPR TO ISSUANCE BY <br />�� <br />PUBLICWORKS <br />TOTAL <br />_ .... nnnnucml In cno CTCOW NIN ( AT 1 <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />