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t.PPLICATION FO1 ` EYEFER <br /> CITECONSTRUCTION e <br /> OF CITY OF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br /> ❑ DEMOLITION COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS � CITY IIP PHONE <br /> �nllePl� f �i Tc) /6 7 yr 5�- C' 4j (�•rr•I�ff qR)n� ',5S.S77 <br /> ARCHITECT OR DESIGNER MAR AO RESS CITU l P DNC <br /> GENERAL CONTRACTOR MAIL ADDRESS CHV ZIP PHONE LICENSE <br /> . _Ln <. A v It1E,rl (�n�: 1',c 24'11 in,lhar� lnJeRAii' 9f71n1 D52- � �/i 12n^krlE,nlYRnD <br /> MECHANICAL CONE ACTOq MAI(ADORE BS COY ZIP PRONE LK[NSE <br /> LIL3F l n�E4f�F 1 T✓Llt LAMA .'45 � <br /> PLUMBING CONTRACTOR M11 ADDRESS CITY ZIP PHONE LICENSE A <br /> 6'eLy h"' _ (f I,r Feal1i FI an6-52 613F_ -/"L <br /> CLASS OF WORK Z' <br /> ❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK ICOST OF MATERIALSPLUSIABOR) rZ) <br /> ..A, <br /> 71�1Pni I 7'ln n I] �n - °Rl <br /> DESCRIBE WORN <br /> 1 ,. w 1< Ilc . r .-• -�Einm <br /> USE OF BUILDING I HEREBY CERTIFY THAT AVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT.ALL <br /> LEGAL DESCRIPTION OF PRO R4OWNBELOWORATi94FOURCOPIES1 PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT_BLOCK_OF IN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> j� ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> O L A T) `4+ &- ew f- 25 S P SIGNATURE OF CONTRACTOR OR AUTHORIZEDAGENT <br /> -�DATE -as 88 <br /> PROJECT ADDRESS APPLICANTSCITVBUSJNESSLIC NS HO j <br /> 6 S'. — <br /> PLUMBING MECHANICAL <br /> KID. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEC <br /> WATER CLOSET ITOILETI A/C-A/HNOLG UNITS-H P <br /> BATHTUB REFRIGERATION UNITS-H P EA. <br /> LAVATORY I W ASH BASIN( BOILERS-B T U IH P <br /> SHOWER GAS FIRED AC UNITS-BTU <br /> JP KITCHEN SINK A DISP FORCED AIR SYSTEMS-B T U M EA <br /> DISHWASHER WALL HEATERS -B FU M <br /> LAUNDRY TRAY UNIT HEATERS-B T U. M <br /> CLOTHES WASHER '.VAPORATIVE COOLERS <br /> URINAL CLOTHES DRYERS <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN <br /> RANGE NOOD i <br /> BACKFLOW PREVENTERS WATER HEATER <br /> ROOF DRAINS-RAINLEADERS WOOD STOVE <br /> SINN(SERVICE-EAR ETC) METAL FIREPLACE 6 CHIMNEY <br /> FIREPLACE INSERT <br /> HEAT PUMP I <br /> GAS PIPING <br /> EXNAUSTFAN <br /> BUB TOTAL f BUB TOTAL <br /> PERMIT f PERMIT <br /> TOTALFEE f TOTAL FEE <br /> 1IAN CHECK NUMBER FEE RECEIPT NO. ' <br /> I RONT SETBACK REAR SETBACK SIDE SETBACK <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE l <br /> OYES ;110 s I <br /> BUILDING <br /> TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> PLUMBING 1 <br /> SIZE r. u:CG NO OF STORIES MAA OCL LOAD MECHANICAL <br /> 1 <br /> OTHER f <br /> FIRE SPRINKLERS REOUIRED ❑ YES NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPIICATIONACF. BY PLANS CHECKED BY APPR FDR ISSUANCE BY PUBLICWORKS <br /> TOTAL <br /> PROPEROWNERS ARE <br /> LOCATIONSA DN RELATED EASEMENTSIBLE FOR BIND ALL <br /> ,I <br /> 1. <br />