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FOiI. <br />CITE"!'°'PER <br />CITY DE <br />. APPLICATION <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION SQ BUILDING ❑ MECHANICAL <br />❑ SION <br />Gw NER MAIL10onE 59f Clry NP m.ONf <br />Cjrc k EY ISe2D 7Znd P/• St. EveJ 9dz03 3S57B�b <br />+NVltlf fl RDEp10.lf <br />MAIL ADORLB9 CIfy !IP PHONE <br />❑ PLUMBING <br />I IYT U�re <br />MMLAPnBESS <br />CEY <br />ZIP PHONE <br />LICEII51 <br />OI NEPEL CONIIIACf OR <br />MECHANICAL CONTPACIOn <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />PLUMBING CONIRACtOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ItCENSt• <br />CU95O. wUN- <br />Ifd NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />V� OmON a wOnP It ^I Or MAItlul s Py O9,JOm r <br />'y1EWO"It �hc/alf a �rivQEJQ43 Pj ►n 14tir �LF con�/Cc�or <br />OE SCRIBE WORu / / <br />On i-n n s <br />USE Or RUILDmn r/` <br />GR,�^ag(� tCr Sm Qi O <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 />uwLOucnlPnoN OE Pnorinrrl HOwN euow On utACHr )COPIER, <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LOT S BL.00I�OF `D� S Ce LB <br />COMPLETED WITH IT ETHER NOT PRESUME HERE - <br />TO <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />IN WORK WILL GRANTING <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BBM Oi COW ALG 55 L04 THOF POQ t,Fr 174 AI lot li <br />ANY CM, TON THER EE PE STATE OR LOCAL OF LAW REGULA <br />I TING CONSTRUCTION <br />N. <br />I�(W_OF iZNO P T EL AL SD S <br />910NATUn Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />W hI.eEFr TB NE uR se LOT T11 S ALG LE LAI SD <br />x 0 �m� <br />L <br />LOT TH I!� <br />PROJECT AODRE 99 <br />APPUCANi9 CITY OIIS JE9S 11 Nf NO <br />tx Vnj PI• SE FVfrg .9a'203 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />AIR COND UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATIO14 UNITS-H.P. EA <br />LAVATORY WASH BASIN <br />BOILERS-H.P. EA <br />SHOWER <br />OAS FIRED AC UNITS -TONNAGE to <br />_ <br />KlIC14EN SINK S DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATER4-11T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-R.LU, M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF GRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />_ <br />SINK SERVICE -BAR, ETC <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL E <br />PERMIT E <br />PERMIT B <br />_ <br />_ <br />TOTAL FEE B <br />_ <br />TOTAL FEE E <br />WE, <br />USE ZONE <br />A <br />TYPE OF CONST <br />'v - <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PEAR SETBACK <br />.,O <br />SIDE SETBACK <br />PLANCHECK NUMBER <br />C 7 rT/ <br />U <br />,'`PLAN <br />FEE �iJ'7+< <br />CHECK FEE <br />RECEIPT NO C <br />LOT AREA <br />�— <br />VACAN(aItE <br />OYESTO <br />FEEBJ <br />VALUATION <br />EEEC <br />OCCUPANCY GROUP <br />/- — / <br />NO OF DWELLING UNITS <br />� <br />BUILDING <br />f co <br />/- <br />0 Vv EyE <br />G <br />NO OF STORIES <br />MAX OCC LOAD <br />IF <br />APPLICAIION ACC By I. AN50IECEED BY API'" IUH I59LN <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />BY <br />TOTAL <br />W-4 <br />