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,--.PPLICATION FOb• <br />evereH <br />CITE""°'"° <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />269.8745 <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />2nzfCFEALTY <br />MAIL ADDRE, f.ITY ZIP <br />SS� <br />Fi�QEi��T7lJLLl�AY �E�EQifTi 9 <br />PHONE <br />3cEg-ab35 -- <br />ARCHITECT ORDESIGNER <br />MAIL ADDRESS CITY ZIP <br />PIIOIK <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY IP PHOHL IICLNSE• <br />MECHANICAL CONTRACTOq <br />MAIL ADDRESS <br />(CITY <br />ZIP PHONE LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE LICENSE- <br />CLASS NEW R ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />USE OF BUIl01ND y^, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUEAND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COMEIR <br />PROVISIONSOF LAWS AND ORDINANCES GOVERN ING THIS TYPE <br />✓Yri�C�si/C9fl �� /� <br />OFWORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />A PERMIT DOES NOT PRESUME TO <br />LOT_�BLOCK--OF <br />IN OR NOT. THE GRANTING OF <br />GIVE AUTHORITY 'TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/-ILA �Dl�7 eLLoT.3 UL[Xi1�7� Y/1//�/� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />UL-' 3 O, <br />SIONATU CONhR.A�CTO�O Oil AU7110A1/lJE/O�A�Of.Nf ,,Aj/,GATE i� <br />X c /c s 0_ 40. (/t v;iLeL4 /Y <br />PROJECT ADDRESS <br />/ <br />APPLICANTS CITY BUSINESS OCENSE NO <br />" <br />o23/2 - 73&:! E1,cAM / h1,0. 98063 <br />070*6 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT _ <br />FEE <br />Z <br />WATER CLOSET TOILE <br />/La <br />('�^^ <br />AIRCOND. UNITS -HP EA. <br />BATHTUB <br />L7 <br />Ly) <br />REFRIGERATION UNITS -II P. EA. <br />LAVATORY WASH BASIN <br />_ <br />BOILERS-11 P EA <br />SHOWER <br />`D <br />I <br />_ <br />GAS FIRED A C_UNITS_TONNAGE EA - <br />_ <br />KITCHEN SINK d IDLER <br />DISHWASHER <br />,�J <br />FORCED AIR SYSTEMS-B T.0 M EA <br />_WALL HEATERS-BT.0 MOl/2O_ _ <br />LAUNDRY TRAY <br />UNIT HEATERS-O T. UM <br />CLOTHES WASHER <br />gZ <br />_EVAPORATIVE COOLERS _ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTIIATIONMN <br />DRINKING FOUNTAIN <br />_ <br />�- <br />-RANGE HOOD <br />F.M�A <br />FLOOR DRAIN <br />AIR IMNOLING UNIT —HOC . <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE L CHIMNEY <br />_ <br />SINK SERVICE -BAR ETC I <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUBTOTAL <br />SUBTOTAL • <br />aJ <br />PERMIT B <br />PERMIT <br />T <br />TOTAL FEE E <br />_ -S <br />TOT1 L FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACKI <br />HEAR SETBACK <br />910E SETBACK <br />PLAN CHECK NUMBER <br />FEEL <br />FE PIAN <br />VAILATION <br />CHECK FEE <br />RECEIPT NO —_ <br />![L <br />HE <br />21 IxE9 <br />LOT AREA <br />y CANT SIIE <br />ONO <br />F CONST <br />OCCUPANCY GROUP <br />NO <br />/L <br />7 DWELLING UNITS <br />BUILDING <br />_ <br />�7 ��L7� <br />o ,r� <br />��� <br />JLJ <br />BLDO <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />�S <br />ck <br />SPRINKLERS REQUIRED O YES ONO <br />MECHANICAL <br />Y <br />CL <br />PENALTY r11' D II <br />�f <br />ATION ACC BY <br />PLANSCHECKEOBY <br />APPA FOR ISSUANCE BY <br />TOTAL <br />O( <br />