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t-%PPLICATION FOl. <br />the EWrgr VA <br />CITY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />0 DEMOLITION O COMBINATION 04 BUILDING ❑ MECHANICAL <br />MAIL <br />CRY zip <br />� �,,QQ� w <br />C 7_p30 <br />❑ PLUMBING O SIGN <br />,5a "4r, <br />Gk NERAL CONTRACTOR MAIL ADDRESS CITY ZU PHONE LICENSE• <br />CUSS OF WORK <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />I /� �A;14 <br />WORK <br />//>,�/SfrycT/ON <br />USEovf,10INa _ �I <br />S/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAMETOSETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETEn 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 3/12 <br />X,a � <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT_BLOCK__OF <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAIT ER CLOSET (TOILET) <br />— <br />MC—AMNOLG UNITS.. H P <br />BATHTUB <br />REFRIGERATION UNITS — H P EA. <br />_ <br />'T <br />LAVATORY (WASH BASINI <br />�-- <br />BOILERS — 0 T U /H P <br />SHOWER <br />GAS FIRED AC UNITS —B.TU <br />KITCHEN SINK A DISP <br />-- <br />FORCED AIR SYSTEMS — B T U M EA. <br />DISHWASHER <br />j <br />— <br />WALL HEATERS — BTU M <br />LAUND,N TRAY <br />UNIT HEATERS — B T U M <br />CLOTHES WASHER <br />C <br />— <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />i <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HUOD <br />5 <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />SO <br />ROOF DRAINS — RAINLEACERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC I <br />METAL FIREPLACE 6 CHIMNEY <br />7 <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />f <br />-- <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />f <br />i <br />L - <br />-- <br />— <br />PERMIT <br />TOTAL FEE <br />111 oN15F 1BAcx :dr— <br />o' <br />IN AN CHECK NUMBER <br />b 9�a� <br />FEE <br />333-j8 <br />RECEIPT NO <br />9 777R <br />REAR SETBACK <br />o <br />IS SETBACK <br />z s' <br />USE ZONE <br />p_ Z,AYES <br />/'o <br />LOT ARE Or <br />VACANT SITE <br />ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />Sr I <br />TYPE OF CO <br />OCCU ANCY GROUP <br />NO OF DWFLUNO UNITS <br />PLUMBING <br />ev— <br />SIZE OF SLOG <br />/,,,�p To. <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />r <br />OTHER <br />y Rio' G'Ar— <br />FIRE SPRINKLERS REOIIIRED O YES �NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />(1T, <br />PLANSCNECKED BY <br />APPR FOR ISSUANCE BY <br />pUBLIC WORKS <br />TOTAL <br />Fv <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />