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A .PPLICATION FO►." evereH <br />CITEF O <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION i? BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />Jnbn C � `( <br />MAIL ADDRESS c"X ZIP PIIOIIE <br />Tkiampsoh &CII,!A -13e i'I 0E (�la -sy'k amuyj 1053``1�3� <br />jh&o <br />U1It A(niHi59 CITY LIP YIIIINL <br />MAt1a-��nY.ror�ti�s qNl 1.'2:ly-A%•WL '440 1A'i �t l I: I3WI <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />5 9,\-q <br />MECHANICAL CONTRACT09 MAIL ADDRESS CITY ZIP PHONE LICENSE F <br />PLUMBINGCONTRACTOR � � MAIL ADD R^ESS/rt CITY l'ZIPP LE 1 �TPHONEI� 1 u Lh,%EN5E• <br />� (l, Y'1tiC [-\UMYI,T,EL �Ci aKi ". S.L�1 nhA5l9Y i0`4�E0 IS-')�I� V <br />GLASS ORK <br />CI'k NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANFERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATEB� 9 PLUS LABORI <br />" USE OF BUILDING E <br />I HEREBY 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 />LEGAL DESCRIPUON OF PROPERTYISHOWN BELOW OR ATTACH FOUR Cr�OP�IESI <br />A <br />, OFWORKWILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br />LOT.3—BLOLI`—oF ELO\BY�icYT'E�.•F!A <br />IN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />X 1 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />S 41 I <br />—ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />ti <br />ISIONAIUR Ji CONTRACTOR OR AUT110RIZC0 AG[NI DATE <br />t Z <br />.A,. .`p 4 \ g.�Uh <br />PROJECT ADDRESS UYY U Vixy—•\'.1+YTV1 <br />G' �a •i <br />•UUNT9 LI DI ISINESS LICENSE NO <br />'\•L) <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />__FEE <br />WATER CLOSET(TOILET)G <br />AIR CONE, LINITS-H P. EA <br />REFRIGERATION UNITS-H P. EA <br />BATHTUB <br />_ <br />LAVATORY IWASH BASIN <br />O <br />BOILERS-H P. EA. <br />SHOWER <br />OAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS-0 T U M EA. <br />_ <br />DISHWASHER <br /><tN I M <br />LAUNDRY TRAY <br />UNIT HEATERS-S 7 U M <br />CLOTHES WASHER <br />0 <br />EVAPORATIVE COOLERS <br />3_ <br />-o <br />R.� <br />Z4 <br />CLOTEIEB DRYERS <br />S}'_ <br />URINAL <br />.�A <br />VENTILATION FAN <br />_Qu <br />f <br />DRINKING FOUNTAIN <br />_RANGE MOOD <br />�,y <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F.M <br />VACUUM _BREAKERS_ <br />T <br />ROOF DRAINS-RAINLEADERS _ <br />METAL FIREPLACE A CHIMNEY <br />SINK SFRVICE-BAR ETC I <br />WOODSY VE/FI E_P—LA.CE• INSERT <br />I /nf'�F <br />SUB TOTAL <br />Q <br />SUB TOTAL i <br />O <br />11 tT <br />PERMIT { <br />PERMIT E <br />I1T <br />TOTAL FEE • <br />TOTAL PE[ E <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT9ETBACK <br />Y 1� <br />REAR SETBACK <br />• <br />SIDE SETBACK Z <br />V <br />PI AN CHECK NUMBER <br />�n /��C��r <br />�1 PI AN <br />FEET `+ <br />CHECK FEE <br />f��y <br />USE lOtlE <br />J _ <br />lOt ARCH <br />VA ANT SITE <br />LS LINO <br />FEES <br />VALUATION <br />— <br />FEE <br />— <br />--' <br />TYPE OFCONST 1 <br />J <br />OCCUPANCY GROUP <br />v <br />NO OF DWELLING UNITS <br />NO <br />BUILDING <br />9RE OI Dl0] NO OF 9Tq TIES MAX OCC LOA" <br />/� <br />-- <br />FIRE SPRINKLERS REOUIRED CITIES ONO <br />PLUMBING <br />MECHANICAL <br />/Y <br />" <br />I� <br />l <br />OTHER f-�, _ K � <br />111���Lf111 <br />/J7 E- <br />EgD <br />e� <br />I-lar�E <br />PENALTY <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APIVL FOR ISSUANCE BY <br />TOTAL <br />�y <br />EY It <br />