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tK'PLICATION h-OR rrPlrtl <br />blr or "° CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />D DEMOLITION ❑ COMBINATION B FUILDING ❑ MECHANICAL 0 PLUMBING ❑ SIGN <br />�yM(q MAIL ADDRESS CITY ZIP PIIONE <br />9AL.-t/0-CC-� <br />OENEIMLCONIRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />1 -54c Az <br />4/ALL/ra -- <br />6'2E:IVf/1 137✓N <br />MECIIAWCAI. CONIRACIOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />1-1 . NFVV ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />usE Ur ouitoola <br />62gwfAL <br />I PL3EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAME TORE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPF. <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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATURE OFCONTRACTOR OR AUTHORIZEOAGENT DATE <br />X g Qti7 -7- to -s-7 <br />LEGAL DESCRIPIIONOr PROPERTY IMIOWN WOW O —ATTACH FOUR COPIESI <br />r(/ <br />LOTIBLOCK—C Or V r ' T ° �' <br />PROJECLADDRESS <br />K <br />APMWANTSCII S SINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />_ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS—H. P. EA <br />BATHTUB <br />Cjn— <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY WASH BASIM <br />C%:) <br />- <br />AOILERS-H.P. EA. <br />2- <br />2 <br />SHOWER <br />KITCHEN SINK&DISP. <br />L <br />CV <br />2 <br />GAS FIRED AC. UNITS -TONNAGE EA <br />FORCED AIR SYSIEMS-B.T.U. MEA. 006 <br />_ <br />C9C <br />2 <br />DISHWASHER <br />LJD <br />j=- <br />WALL HEATERS-B.T.U. M <br />_ <br />rz' <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER THEATER <br />DO <br />UNIT HEATERS=B.T.U. M <br />EVAPORATIVE COOLERS --- <br />CLOTHES DRYERS <br />1�± <br />_ <br />-- <br />-� <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />_ <br />FLOOR DRAIN <br />- <br />AIR HANDLING UNIT- C.F.M. <br />r <br />VACUUM BREAKERS <br />STOVE <br />- <br />--- <br />ROOF DRAINS-RAINLEADERS <br />- <br />METAL FIREPLACE S CHIMNEY <br />SINK SERVICE -BA ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />BUB TOTAL <br />SUB TOTAL t <br />_ <br />PERMIT • <br />PERMIT t <br />TOTAL FEE <br />MIMI <br />I TOTAL FEE t <br />TEL <br />3a <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK BIDE SETBACK PLAN CITE KNUMBER ^ PLAN CAECA FEE <br />USE ZONE LOIAREA VACANT SITE FEES VALUATION V FEE <br />'—•/.' AYES ONO <br />COySi <br />OCCUPANCY Gnoup <br />JCn 9 <br />NO OF DWELLING UNITS <br />'a" <br />1;. <br />BUILDING <br />A1110 <br />NO Or STORIES <br />MAX OCC ICAR <br />PLUMBING - <br />PRINNIERS REOUIREO OYES �� NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />IIONACC BY <br />at <br />PLANS CNECKEO BY <br />� <br />APPN Ton ISSUANCE BY <br />t. <br />TOTAL <br />!-� <br />