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U <br />IAE Ewpamin <br />Clh OF <br />everett <br />BUILDING DEPARTMENT <br />259-8145 <br />❑ DEMOLITION <br />. A-IPLICATION FO._ <br />CONP STRUCRM TTION <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />I] COMBINAI[ON 0"©UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />.1/ <br />GLNENAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PNONr <br />LICFNAF A <br />J.... - <br />NOC Nf LCONTRACTOR <br />-• Ce 641s— <br />MAIL ADDRESS <br />CITY <br />ZIP <br />�L'�!(//<I <br />PHONE <br />CSC /'%' <br />LICENSE, <br />PLUMRIN(ICONINACIOR MAIL ADDRF-S CITY ZIP PHONE LICENSE <br />OJ'NEWM ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />IAl UATION OF WORK ICOST Or MATERIAL R PLUS LABOR, <br />7 4-4a, nm. 60 <br />/Y r /s: r„ <br />usr Or BUILmMa F <br />'� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHESAME TOBETRUE AND CORRECT. ALL <br />PROVISIONS OF 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE F CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRI, TIONDr PROPERTVISHOWN BELOW OR A)ACH FOURCOPIES, <br />��oi/�''2 B,ocK3oF s-�L�L �w- /J, <br />P JECI ADDRESS <br />APPLICANrB CITY11USINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />No. <br />TYPE OF FIXTURE <br />WATER CLOSET TOILE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />AIRCOND.UNITS-H.P.EA <br />FEE <br />'Z <br />BATHTUB <br />Idl= <br />REFRIGERATION UNITS-H.P. uA <br />n <br />LAVATORY IWASH BASIN, <br />BOILERS-H.P. EA <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />OAS _IRED AC. UNITS -TONNAGE EA <br />FORCED AIR SYSTEMS-B.T.U. MEAL <br />DISHWASHER <br />Gil <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-0 T.U. M <br />CLOTHES WASHER _ <br />00 <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />RANGE HOOD <br />_ <br />o <br />_ <br />DRINKING FOUNTAIN <br />_ <br />FLOOR DRAIN <br />_ <br />AIR HANU_jtNDNIT- CF.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WTOODSTOVEJFIREPLACE INSERT <br />_ <br />BUD TOTAL <br />SUBTOTAL • <br />PERMIT • <br />PERMIT • <br />__ <br />TOTAL FEE • <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY 13UILDING DEPT. PERSONNEL <br />IT If IUACK <br />'Lo <br />RLAR SETBACK <br />Lo <br />SIDE SETBACK <br />T <br />PLANCHECK NUMBER <br />L// <br />iii <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO E� <br />dt f <br />fONf <br />R-z <br />LOT ART AA <br />72'2'7 SF <br />VACANT SITE <br />I#ES ONO <br />FEES <br />VALUATION <br />FEE <br />Or CONS,,f <br />�—N <br />OCCUPANCY unall <br />,9 -/ <br />NO OF DWELLING UNITS <br />' <br />BUILDING <br />! <br />(j <br />♦il <br />'" BI PO .I <br />T, R�/•S♦ `-34 mi <br />NO OI STORIES <br />MAX OCC LOAD <br />I <br />PLUMBING <br />,q <br />SPRINKLERS REOUIREO DYES NO <br />MECHANICAL <br />O <br />OTHER <br />PENALTY <br />UIION ACG BY IMANSCHECKEODY <br />E� <br />APPR FOR168VANCE SY <br />[_ . G <br />TOTAL <br />AddP/an chick FP! ReveIrml = 1,0, 95 <br />AceF,af # 799d5 <br />