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I <br />IFS <br />r%PPLICATION FOk.' BYEFBR <br />CITEF"°"°° <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. ETA <br />259.8745 ❑ COMBINATION ry BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADORFSS OFF ZIP PHONE <br />l3G2`.1t'LsJ2 AP ,417- / �/ J d,�Q�i/-MAGL� F✓/_- P98?vyfllNl E 34ft� ^ 36 3 S <br />OFNERAI CONTRACTOR MAIL ADDRESS CITY ZIP PHONE _ 't� IICE14SE <br />—r TL./.,✓<:�/ _joy t�/6�Al�E3TFii°�/S�O.F—A0167 9�k, 0 1 Y <br />uerwuvu rnurommR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MAIL ADDRESS CITY ur <br />C4990F WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEITRPLANSERT ❑ BUILDING RELOCATI: U <br />WLUATIOZTOF WOAKICOSTOF MATERIALS PLUS LABOR <br />DESCRIBE 7 <br />RK l <br />USE OF BU1; , <br />AL.At <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTYIBHOWN BELOWORATTACH FOURf.OPIESI <br />O <br />/Nf �iLFSr 9L/% lor313A&. <br />cic <br />OF WORK WILL BE COMPLETED WITH WI IETHER SPECIFIED HERE• <br />Lor�BLocK_oF <br />IN OR NOT. THE GRA14TING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO14S OF <br />,/ /� <br />A5 RWfh(t.)A57- Jfi Y • B• 449 3s <br />ANYOTHER STATE OR LOCAL <br />THE PERFORMANCE OF LAW REGULATING CONSTRUCTION <br />TRUCT ON. <br />OF CONTRACTOR OR AUTHORIZED AAULHT DATE <br />SIGNATURE <br />=1101BUSINE5SLICENSE <br />PROJECT ADDRESS <br />6�i0.99ZB3 <br />APPI NO <br />O70 #.e <br />3/ — 73 of'Z-M'i' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEF <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET TOILE <br />1= <br />AIR COND UNITS_HP EA. _ <br />BATHTUB <br />45al <br />REFRIGERATION UNITS-H P. EA. <br />LAVATORY WASH BASIN <br />L O <br />Cc- <br />BOILERS- H.P EA. <br />SHOWER <br />j <br />GAS FIRED A . UNITS -TONNAGE EA <br />KITCHEN SINKS DISP. <br />S <br />i <br />ORCEO AIR SYSTEMS-B T.U. M EA <br />DISHWASHER <br />WALLHEATERS-B.T.U. M2,",20 <br />LAU-NDRY-TRAYY <br />s` <br />_ <br />UNIT HEATERS-R T.U. M <br />COOLERS�- <br />CLOTHES WASHER <br />PC) <br />FVAPORATIVE <br />CLOTHES DRYERS Ej <br />y" <br />WATER HEATER <br />VENTIlAT10N FAN <br />UQ- <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />_ <br />_[_ <br />RANGE HOOD <br />AIR IIANDIING UNIT- 0 C F.M. TCIC . <br />FLOOR DRAIN <br />! <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACES CHIMNEY <br />SINK SERVICE -BAR ETC.I <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT F <br />_ <br />PERMIT _ f <br />_ <br />TOTALEEE ! <br />7 <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />ti6)r( <br />REAR SETBACK <br />2cIDF-7 <br />CK <br />SIDE SETBACK <br />(v! <br />PLAN CHECK NUMBER <br />CE�. <br />G V <br />D/ PLAN <br />fEk(J <br />CHECK FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />QYES ONO <br />FEES <br />VALUATION <br />-- <br />FEE <br />__ <br />_- <br />TYPE OF COIN/ST. <br />V'^N <br />OCCUPANCY GROUP <br />pv —_3 <br />NO OF DWELLING UNITS <br />' <br />BINLDING <br />E¢7€�aD EYJ <br />t <br />BlO <br />SIZE F00 <br />� L <br />NO OF STORIES <br />MAXMAK OCC l0A0 <br />PLUMBING <br />4! <br />e� <br />VO <br />FIRE SPRINKLERS R:OUIHED O YES ❑ NO <br />MECHANICAL <br />— <br />Q U <br />OTHER <br />ry <br />PENALTY <br />APPLICATION ACC BY <br />PUNS CHECKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />y <br />�� <br />