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IREErupnFn �.PPLICATION FOh-' E,PFYN <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION N BUILDING ❑ MECHANICAL O PLUMBING Ll SIGN <br />owrRn MAIL ADDRESS cow rH• PHONE <br />LEE Mc.F_I-VATE.1C ItioI-(D3Rh AT EIII EIter r 11S203 355ZS'iS <br />ARCHITECT OR DESIGNED MAIL ADDRESS CITY V, PIIONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP MIONE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />❑ NEW Io ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/F RPL. INSERT ❑ BUILDING RELOCATION <br />A CAAA)Lr <br />USE OF BUILDING <br />h�0.1CINV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOTPRESUME 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 FCONtRAACIOR OR AUTHORIZED AGENT DATE <br />X ✓// ' <br />,// ! 11 10 8 <br />LEGAL DESCRIPHwr Or Prorc nl rl9HF1WN mLOW On A I IA04 roan r OP¢s <br />LOTA-BLOCIr�Or }I QI�• Z <br />_ <br />PROIECT ADONE 55 <br />IIiUI - 634?b SF. Ucks:TT <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET j7OILETj <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />_ <br />LAVATORY IWASH BASRA <br />BOILERS-H.P. EA <br />SHOWER <br />OAS FIRED A.C. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. MEA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNORYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE • CHIMNEY <br />SINK SERVICE -BAR ETC. <br />WOODSTOVEIFIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL IT <br />_ <br />PERMIT IT <br />PERMIT t <br />TOTAL FEE • <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />20 <br />USE ZONE _ <br />R <br />REARSEIBACK <br />Zo <br />LOT .E, ^OD <br />G JY <br />SIDE SETBACK <br />5 <br />oYEH SITE <br />O <br />PLANCIIECKN MSfR <br />� / � �(3 ` <br />FEES <br />TYPE OF CONST <br />-Z_116� <br />OCCUPANCY GROUP <br />M, I <br />NO OF DWELLING UNITS <br />BUILDING f <br />1 <br />SIZE OF UO E� <br />SQ �� <br />NO Or STORIES <br />I <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REOUIRED O YES TO NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATIONACC BY <br />`5c <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />L' If, <br />TOTAL <br />TOTAL <br />zs Acx�r, <br />/ �+�� IRELlIeiNOZ� J15 <br />VALUATION dd. FEE <br />Pau GA16rA::.rZ: <br />