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FO:_. <br />CAFE""°'"R <br />CITY OF <br />-.PPLICATION <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />4 <br />❑ SIGN <br />ARCHITECT On OE FIONf R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PRUNE <br />LLIA:dSCslsf�tR <br />OE NERAL COIIIRACIOR <br />LE� <br />MAIL App nFSS <br />=�� 3C�;Ly� <br />CITY <br />I,/ IT�II <br />ZIP <br />`i81 d 1 <br />PIIONf <br />255 r» 7 <br />ICENSE A <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />city <br />ZIP <br />PHONE <br />LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIIONF <br />LICENSE <br />CLASS Or WORK <br />I] NEW ❑ ADDITION <br />❑ ALTERATION ❑ <br />THE) .ul <br />❑ DEMOLITION x <br />WOODSTOVE/FRPL.INSERT <br />❑ BUILDING <br />RELOCATION <br />VALUATION Or WOAN ICOST OF MATERIALS PLUS LABORI <br />P <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORKWILL BE COMPLETED WITH WHETHER`1PECIFIED HERE- <br />IN OR NOT. THE GRANTING OFAPERMITDOESNOTPRESUMETO <br />R CANCEL THE PROVISIONS Or <br />ANY O HTER STATE OR LOCAL LGIVE TO VIOLATEAW REGULATING CONSTRUUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON;,TOR OR THORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPS RI♦ISIIOW BE LOW on ATTACH roun corlrim <br />/1Y T 7 Q <br />LOT_BLoc2oE�a <br />PROJECIADDRESS <br />APPLICANrsc USINE95LICENIEND <br />PLUMBING <br />MECHA ICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILE <br />_ <br />_ <br />AIR COND. UNITS—H P. EA. <br />_ <br />REFRIGERATION UNITS—H.P. EA. <br />_BATHTUB <br />LAVATORY IWASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />OAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEAUERS <br />_ <br />,METAL FIREPLACE A CHIMNEY <br />_ <br />SINKJ9ERVICE—BAR, ETC. <br />WOODSTOVEIFIREPLACE INSERT <br />_ <br />SU_D TOTAL <br />SUS TOTAL A <br />_ <br />B <br />PERMIT <br />TOTALFEE B <br />_PERMIT <br />TOTALFEE B <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />NEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />iEE nEOEIPI No <br />101 AnfA VACANT SITE <br />rffS VALUATION rfF <br />OYES ONO <br />TYPE Or CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br />SIZE OF BLDO NO Of STORIES MAX OCC LOAD <br />APPLICATION ACC BY I PLANSCHECKEOBY <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />S <br />