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IA[EYtrpr„R . APPLICATION FOB, <br />city of CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />DWN[P MAEA y <br />DRESS CITY ZIP <br />r LI n h --/( J.a <br />❑ PLUMBING ❑ SIGn <br />PHONE <br />ARCH,I I C I OR DESIGNER <br />MAR ADDRESS <br />CITY <br />ZIP <br />pHOILE <br />GENERAL CONI�IPA <br />MAR ADDRESS <br />DIN <br />LIP <br />PHONE <br />LICENSE <br />_- -, e <br />MF/ o'-wIT <br />/801,17 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRE58 <br />CITY <br />ZIP <br />PHONE <br />LICENSE . <br />PLUMb.N,IC0NTRAC`OR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />Cl ASS EU WHIN <br />❑ NEW ❑ ADDITION ❑ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ CUILDING RELOCATION <br />/,V._-I D7 "G /"A•+..b14 J/1.r /_l IrLla .i /_�/'YN <br />USE Of BUILDING - <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 />PROVISIONSOF LAWSAND 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 />SIGNATURE OF CONTRACTOR OR AUTUORIIEO AGENT DATE <br />X ��� <br />LEGAL DESCRIPTION OF PROPERTY ISHOYO4 BELOW OR ATTACH FOUR COMEM <br />�l - i.s,�Ltr <br />PROJECT ADDRESS <br />APPIKi1NrSCITY BO INE99OC-NSE NO <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILER <br />44FEENO. <br />AIR CONE) UNITS -II P. FA <br />BATHTUB <br />REFRIGERATION UNITS -HP EALAVATORYYIWASR <br />)BASIN <br />BOILERS-HP EASHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A OISP <br />FORCEDAIRSYSTEMS-BTU MEA <br />DISHWASHERWALL <br />HEALERS-BTO M <br />LAUNDRYTRAY <br />UNIT /)EATERS-BT UMCLOTHES <br />WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAT N <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOODIII <br />rl <br />FLOOR DRAIN <br />AIR 14ANDLING UNIT- C F M <br />VACUUM_ BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR. ETC <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />•A °ti <br />BOB TOTAL <br />BUD TOTAL <br />PERMIT • <br />PERMIT t <br />TOTAL FEE t <br />_ <br />TOTAL FEE <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT BE TBACN <br />REAR SETBACK <br />•-^' I <br />SIDE SETBACK <br />l) <br />PLAN CHECK NU DER <br />�b ,705 <br />t, <br />I rPI AN <br />EEE 4l SIC, <br />CHECK FEE <br />RECEIPT NO <br />1,]E LONE <br />l <br />LOT REA <br />I <br />VACANT SITE <br />OYES ONO <br />F[[! <br />VALUATION <br />/l! <br />— <br />TYPLOFCONfI <br />OCCUPANCY GROUP <br />NO OF OWE LINO UNITS <br />BUILDING <br />t �1 f� <br />M— <br />BIR Or BI pO <br />I ' - <br />NO or B1H 0Rl <br />MAIL OCC lOA <br />�� <br />PLUMBING <br />V d <br />IA.'A11/T x':-3 / <br />FIRE SPRINKLERS REQUIRED O YES 0 NO <br />MECHANICAL <br />GO <br />OTHER <br />-- <br />T� <br />PENALTY <br />APPI ICAIION ACC BY <br />n� I I I <br />PLANSCHECKEDBY <br />/t✓(C. <br />APPR FOR ISSUANCE BY <br />� �./ <br />TOTAL <br />L �! <br />i <br />