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.,PPLICATION FOB.'' <br />CAB Ewrpnrn CONSTRUCTIONCITY of evrreN <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OW pR MAIL ADDRESS ( X CITY ZIP PHONE <br />,C at 'iv.A.-A" ti, 2 �'=s 7 �u ll1L v{��.v ji Z s 3 ._ IlC—/. <br />I L.".NE <br />J \ <br />'} �! • . E. J !' . 71 rt • : t L' `7I 1 l �ii�/' li/rL rr�J7 _?� ,�.5 F w 73 y�4iL'• Lo iG �s—fee <br />ITN CHANICAL CONTIMCT09 MAIL AD RESs CITY ZIP MNONE LICENSE—/-} <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />cues of won. <br />EI�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR 1-1DEMOLITION❑ WOODSTOVE/FRPL, INSERT ❑ BUILDING RELOCATION <br />VALU %TION OF WOnK ICOST OF MA II nuts PLUS LASOM <br />USE OF BUILDING <br />jol L d-.4.�_ <br />' <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 LAWS AND ORDINANCES GOVERNING THIS TYPE <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 TO VIOLATE OR CANCEL THElr NS OF <br />ANYO HER STATE ORLOCAL LAW REGULATING CONSTRUUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATUOEOFCONIRACTOR RAUTHOn1ZE0 AGENT DATE <br />1 , Y <br />LEGAL DERCRIP110ND OPERTY 13"qWN BELOW OR ATTACH FOUR COMES <br />LOI_RLOCK__or <br />'OO 'DO D d <br />PROJECT ADDRESS <br />.�-613 7 <br />APPL NrSC1TY BU9MEB9lICENSE NOv <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />_MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY IWASH BASIN <br />BOILERS—H.P. EA. <br />SHOWER <br />OAS FIRED AC UNITS —TONNAGE FA <br />KITCHEN SINK DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATER" T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I <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 />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- 'IAINLEADERS <br />METAL FIREPLACE E CHIMNEY <br />SINK SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />_ <br />TOTALFEE S <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SEIRACK <br />'yAi <br />REAR SETBACK <br />SIDE SETBACK <br />�y I <br />PLAN CHECK NUMBER <br />Y! <br />�jP�LAN <br />FEE G (� 11 <br />CHECK FEE <br />RECEIPT NO O F <br />T <br />USE sDNFJ <br />LOT AREA <br />VACANT VIEO <br />OYES *0 <br />PEER <br />VALUATION <br />FEE <br />EI'PIIAf �'gflE =[ril• <br />lrI( <br />I <br />IV <br />TYPE Or Cores? <br />OCCUPANCYOROVA <br />" • , / <br />NO OF DWELLING VNII9 <br />BUILDING <br />E <br />go <br />sGE OF BI DO <br />I��U <br />NO OF 9TOIBES <br />MAK OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED O YES NO <br />MECHANICAL <br />1 <br />OTHER yl 11/•1 lt�bl <br />ZU <br />DO <br />PENALTY <br />APPLICATHJNACC BY <br />MANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />LI G <br />TOTAL <br />111 <br />y <br />