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E. <br />t.PPLICATION FOk <br />IAAEwrprNn <br />CITY OF <br />CONSTRUCTION <br />1461 <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION OLBUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWN, 14 <br />MMI ADDRESS CITY ZIP <br />PHONE <br />.f <br />39AD-AvO;'i/ iJe-� %. %C..IQ ;ry <br />�.rx -wll?S <br />z9�� <br />IP <br />PHONE <br />GENERALLC^CONTRACTOR <br />MAIL ADDRESS ZIP <br />PHONE N1st• <br />3/�7 i <br />A� — �. <br />——oh <br />Z�IKA <br />�i /A�➢C F �J <br />MCf.HANIULCONtgACTOq <br />MAIL ADDRESS SIP <br />PHONE LICENSE- <br />PtUMBINGCONT114"of; <br />MAIL ADDRC55 CITY JIv <br />PHONE IICENSE• <br />F�'F' <br />ClAS'i OF WORM <br />NEW ❑ ADDITION ❑ <br />ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VA All NOF WORKICOSI OE M4CRIAl <br />n, US I AROM ego <br />OE SCRAP. W Fa <br />USE OF BUIt DING <br />toga /Y7 t' '17� �`� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />PLICATIONAND KNOWTHESAMETO BETRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <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 />SIDI IATURE OFO/JFr?/�_ NTRACTOR OR AUTHORIZED AGENT OATf <br />APPLILAll 1CHy DI .. ❑2;F'.n — f--- <br />LEGAL DESCRIPTION OF PROPERTY [SHOWN BELOW OR ATTACH I OUR COPIE SI <br />EDI BLOCK OF <br />Gt,-- <br />PROJIL:T ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET I TOILETI <br />167 <br />OO <br />A/C -- NHNOLG UNITS — HP <br />BATHTUB <br />Igr <br />REFRIGERATION UNITS — H P EA <br />LAVATORY (WASH BASIN) <br />i'o <br />OJET <br />BOILERS — BTUHP <br />SHOWER <br />GAS FIRED AC UNITS — BTU <br />KITCHEN SINK A DISP <br />5700FORCED <br />AIR SYSTEMS — B T U M EA <br />DISHWASHER <br />WALL HEATERS —B.TU M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />Cfa <br />FLOOR GRAIN <br />RANGE MOOD <br />35 <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC I <br />METAL FIREPLACE B CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />F11UN1 SD EIAC. <br />PLAN CHEfK NUMBER <br />FEE �Ll <br />RE�IPT H Q <br />REAR SE TSACF <br />BIOF SETBACK <br />Set <br />USEZONE <br />L�OTTAREA <br />X, 6oc0 so Ft. ? <br />cwtsTE <br />XES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />3B <br />TYPE OF COAST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SME OF BLDG <br />3�H NE>K�LrAa_ <br />NO Of STORIES <br />Z <br />MAX GCE. LOAD <br />MECHANICAL <br />/i <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES kNO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICA If ON ACC By <br />L�,wG\_%/y]A7,/NAj� <br />PLANS CHECKED BY <br />�[i% <br />APPR/FOR ISBUANCE BY <br />Ij . • <br />PUBLIC WORKS <br />TOTAL <br />YNV YCm r VYYIYcna nnc nwrvnv�.� • �• • •-�._....... _..._..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />