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BPPLICATION FOL c G'N <br />CONSTRUCTION oGul"..1�P 3�� P,PIPN <br />IAE frvprMA <br />un OF <br />everett PERMIT 161-3 <br />BUILDING CEPARTMENt 259-8e10 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ BUILDING X MECHANICAL <br />O PLUMBING ❑ SIGN <br />O DEMOLITION <br />U COMBINATION <br />IWOn <br />�o�p <br />MAIL ADDIIESS <br />z��, �i�;��� <br />OTY bP <br />A�� �. se,�ll� �V//g <br />PHONF <br />PHOTO. <br />ARCHITECT DT 9UI1[a <br />MAIL ADDRESS <br />CITY bP <br />_ <br />MAIL ADDRp4 <br />CITYNCIVN <br />En• <br />PI'ONI . <br />OLNTPAL CONINACIOR <br />n.n. vm <br />FHUNE 11[ 1'1••1 . <br />CLASS OF WC Ar. <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TIFMOLITION ElWOODSTOVE/FRPL.INSERT BUILDING RELOCATION <br />Aq VOQN Of W9nr "All "'At S 1'l US LAROM <br />I /1 <br />DF SCR -BE WOnr Ln/.FnII <br />.'.�.- dG l.. i.]Yvf il/i to <br />u%I Ol a.:n �D'1j"m <br />OJJ I C C A.)orc flQL Sc <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AM1 <br />PLICA71ON AND KNOW THE SAME TO DE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS T YPE <br />OF WORK WILL BE COMPLETED WITH W14EI11EA SPECIFIED HERE• <br />GI ERAUTHORITY TNOT. THE GRANTING OF ITDOES S <br />O VIOLATE OR CANCEL THE PROV SIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONT rACTOR OR AUTHORIZED AGENT DATE <br />x <br />1EMI aTKEPI^VON nt PROPLa1Y ISIIIIWN BCLOW Ua AttACHf OUa COP1[!N <br />lel_mor.r_el <br />- <br />PROIEG Aban(SS 1 <br />PLUMBING <br />APIgNO <br />ICANT. CITY aw..'ESSTIC t.�[ <br />- <br />MET -lee <br />-lee <br />NO. TYPE OF EQUIPMENT FEE <br />AIC - AIHNOLO UNITS — H IT <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET ITORE TI <br />FEE <br />BATHTUB <br />REFRIGERATION UNITS —HP, EA <br />AVATJRY HYASN BASINI <br />BOILERS — B.T.0 rH P. <br />_— <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DIEIIWA$NER <br />LAUNDRY TRAY <br />OAS FIRED A C. UNITS — B.T.0 <br />FORCED AIR SYSTEMS — B T U. M EA <br />WALL HEATERS —B.T U. M <br />UNIT HEATERS — B T.U. M <br />-_ <br />'— <br />cL'JTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />URINAL <br />CLOTHES DRYERS <br />— <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />DACKFLOW PREVENTERS <br />WATER HEATER <br />—� <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />—� <br />SINK ISERVICE — BAR. ETC 1 <br />METAL FIREPLACE ►CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />i EA 1 OltL <br />SUB TOTAL <br />4 <br />BUS TOTAL <br />PERMIT <br />L <br />PERMIT <br />r <br />TOTAL FEE <br />•� <br />FEE <br />TOTAL 4 <br />I nynT SEtpgr <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />PEAR —SETBACK <br />SIDE SETBACK <br />UST ZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />hP( OF CO'gl <br />OT:SUPAlICY GROUP <br />ND —Of DV?L11110 UIIII9 <br />PLUMBING <br />SIZF OI BI GO <br />NO TIE STORIES <br />MAIL OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />_ <br />AI'PIICAtIONACC Br <br />^LANE CIIECKED BY <br />APPR roll l;SuAN[.I Br <br />PUBLICIVORKS <br />TOTAL <br />/ <br />I ... --15 Anc n1:RnnNRIRt <br />P FOR DETERMINING <br />ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS, <br />