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\,{PPLICATION FOrc� <br />eryoro�R <br />CONSTRUCTION <br />�YETE„ <br />everett <br />PERMIT <br />3 BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />EODRESS I C11P/ �s 21P <br />PHONE'] <br />ARCHITECT OII 9ESIGNER <br />MAIL ADDNFS9 COY lip <br />PHONE <br />GENERAL CONTRACTOR <br />ti1A1lILK <br />MAIL ADDRESS lIP <br />1P - Ilc'aE•�l IVi�lk��(��ILcL��{�l I `i Lit_ <br />PHONE / <br />c�r��Sd�1L/� �17��7t��c <br />U E SE <br />'j MECHANICAL CONTRACTOR <br />MT L ADUREBS CRV ZIP <br />PHONE LICENSE <br />� <br />l <br />/ <br />^LUMBINGCCNtRACTOR <br />' <br />MAIL ADDRESS City lU <br />PHONE LICENSE <br />CLAS6 Of WORK <br />Cl NEW ❑ ADDITION EVALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />I VALUATION OF WORAICCRT OF MATERIALS PLUS LABOR, <br />T DESCRIBE WORK I <br />V / , A"-J I <br />1 wi 0 ILIv IITLC l Llyl 11 1 <br />L 1_ <br />-. <br />I <br />UBEOF euI ,Na v <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 7'o <br />LEGAL DEBCRIPNON OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_SLOCK� OF <br />PROJECT ADDRESS <br />, / <br />API IANTB CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />A/C — AIHNOLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T U /H P <br />SHOWER <br />GAS FIRED A C. UNITS — B T U <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS — B T U. M EA. <br />DISHWASHER <br />WALL HEATERS — BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — F;AINLEADERS <br />W007 STOVE <br />SINK (SERVICE —BAR, ETC) <br />METAL FIREPLACE A CHIMNEY NOT - - LE <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUJT FAN <br />SUB TOTAL <br />i <br />SUB TOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO . <br />I RONT SE TBACk <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT 817E <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF aW'ELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICAIIONACC By <br />PIANSCHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />rnvrc I I ....n...... . <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />