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°!"R <br />CONSTRUCTION , <br />cirl OF <br />everett <br />PERMIT E <br />BUILDING DEPARTMENT <br />259-8745 TO <br />BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION O COMBINATION O BUILDING 0 MECHANICAL ❑ PLUMBING ❑ SIG <br />OWNER MAR AOORE88 CITY 71P PHONE <br />ARCHITECT ORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br />OLNERAL CONIRACIOB MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MICHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP NIONE LICENSE A <br />YIHMBINJ CONTRACTOR MAIL ADDRESS CITY ZIP NIONE IK:EIISE• <br />CL ASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATI01 <br />VAL UANON or WORK (COST OF MATERIALS PLUS LABOR, <br />_ <br />nl B Iuut WORK <br />USI OF BUN DIN, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS Al <br />PLICATIONAND KNOW THE SAME TORE TRUE ANDCORRECT. AL I <br />I I GAL DESCRIPTION OF PROPE RIYISHOWN BELOW C.R ATTACH FOUR COPIER <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPI <br />//// 1 <br />L� _ <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERI <br />Lu1�BLocI`._oF <br />IN OR NOT. THE GRANTING OFA'ERMITDOES NOT PRESUME T( <br />GIVE AUTHORITY TO VIOLATE Oa CANCEL THE PROVISIONS OI <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO1 <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />r �) <br />X l i •� / 2/ <br />�• <br />PROIECIADDRESS <br />APPLI, r8CI1Y NESSLICENBE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />i <br />1 WATER CLOSET TOILEI) <br />-� <br />AIR COND UNITS-H P. EA <br />2. <br />BATHTUB <br />REFRIGERATION UNITS-H P. EA <br />_ <br />LAVATORY IWASH BASINJ <br />BOILERS-H.P. EA. <br />SHOWER <br />OAS FIRED AC UNITS -TONNAGE EA <br />I <br />KITCHEN SINK& DISP <br />FORGED AIR SYSTEMS-B T.0 M EA <br />DISHWASHER <br />WALL HEATERS-B T. U. M <br />LAUNDRYTRAY <br />_• <br />UNIT HEATERS -BTU M___ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS___ <br />VATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR GRAIN <br />AIR HANDLING UNIT- CFM. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERB <br />METAL FIREPLACE & CHIMNEY <br />SINK IBERVICE-BAR ETC <br />WOODSTOVE/FIREPLACE INSERT <br />-_ <br />_ <br />U <br />b-C <br />BUD TOTAL <br />BUB TOTAL <br />_ <br />PERMIT <br />A <br />_ <br />P EWT-- If <br />TOTALFEE <br />B <br />TOTAL FEE B <br />THIS PORTION TO BE <br />COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />ROAR SETBACK <br />BIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />f/ <br />r <br />T <br />FEE q <br />RELEIPINO <br />LOT AREA <br />VACANT SITE <br />USL :ON[ <br />O [ <br />Ii <br />' <br />� ---- <br />PB <br />Pan <br />VALUATION <br />T • <br />p• �'% j C <br />ONO <br />FEE <br />"PC Or EGOIST <br />C r` <br />OCCUPAEILCYGROUP <br />NO OF DWELLING UNITS <br />, <br />1l <br />BUILDING <br />B � F <br />•--3 <br />�i <br />NO OF STORIES <br />MAX OCC LOAD <br />SIZE or BL Do <br />•'.J. <br />- <br />PLUMBING <br />—.— <br />�•i'/' /' 'I <br />I <br />MECHANICAL <br />iIRG SPnINKI EHS REOUIREU UYES ❑ NO <br />OTHER <br />i <br />UPIILAIION ACC EY PIANECH[CKEG BY <br />PENALTY <br />APPD lOR 195UA4CE BY <br />TOTAL �Q <br />