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IA. EwrBEMII <br />APPLICATION F G Bt <br />.YP,ER <br />i city OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />I BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />i OWNER <br />{�i4iNE FiPln <br />MAILADORESB Y CITY ZIP <br />/,c'P�TsiAAl�/ (I�.;Te (nDoN;;1 <br />PHONE yHPlere2 <br />z_ I�Ic,.64 "t,7 <br />Riezo/lJ!!) 1514.0-0 w# <br />ARCHITECT OR OEB/iO�NFR <br />MAIL AODREBS CITY ZIP <br />PHONE <br />SNoUP�PS�I'nA7PtrTeN <br />yolb /yB�/1/E �, YLro Fgos.? f38i-4z1f <br />sAO0q,T2Zz t3 <br />G_HEML CON�I RQPG_IOI)),�� <br />n MAIL ADDRESS CITY ZIP <br />PHONE S,LZVUq�lIG[ NSCK <br />SND I/9LLyIlo�tsleueliu� <br />yo/(�/y�'`�,Qt�PUE Kemnowo <br />04YB�� t�7_?%5zzP� <br />MLCHANICAL CONTRACTOR <br />MAIL ADDIIf SS CITY ZIP <br />PHONE IMETISE <br />I UMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE LICE USE • <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />val UAI ON Of WORK ICOST OF MATERIALS P.US LABOR72s000 <br />DESCRIBE WORN n <br />`7e-Alov% /n9noodemeA7J Rio U/Ji/nA Za.,,.. XZ <br />USE OF BUILDING v—r <br />I <br />' HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATIONAND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br />IN OR NOT. THE GRANTING OF A PERMITDOES 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 />SIONAT�URLOOF CONTRACT R OR AUTHORIZED AGENT DATE <br />AI'PLICANTSCITY BLIS ESS LICENSE NO <br />C <br />LEGAL DESCRIPTION OF PROPERIYISHOWN BELOWORANACH FOURCOPIESI <br />IoreLxK_oF <br />PROJECT ADDRESS <br />420 %S s'Tsca <br />_PLUMBING <br />MECHANICAL <br />_ NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET ITOILEI) <br />30 <br />AIRCOND UNITS —HP. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H P. EA. <br />LAVATORY IWASH BAST <br />BOILERS—H P. EA. <br />SHOWER <br />GAS FIRED A C UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS-8 t.U. M EA <br />DISHWASHER <br />WALL HEATERS-6 T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-0 T.U. M <br />CLOTHES WASHER <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— CFM <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINN SERVICE —BAR. ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />rK <br />SUB TOTAL B <br />PERMIT S <br />_ <br />PERMIT S <br />._ <br />TOTAL FEE B <br />TOTALFEE S <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />USE ZONE (LOT AREA I I VACANT <br />DYES ONO <br />TYPE Of COAST OCCUPANCY GROUP NO OF DWELLING UNITS <br />'Sr 1 HR ALT1 62 <br />'LIGATION ACC BY PLANS CHECKED BY APPR IORISSUAN <br />E-•`S �v,rn e G. <br />3.S 76 <br />FEES <br />BUILDING <br />PLUMBING <br />ME'HANIrAt <br />OTHER <br />PENALTY <br />TOTAL <br />FEE//O r� (RICER, NOG� <br />bL <br />• O <br />L <br />(iJ F 1 <br />(ee�yy�` LLur-'l <br />3 C <br />