102 77TH PL SW 2016-01-01 MF Import

the EHtOfIT.R ` ,..'PPLICATION FO..-' BYFFBR CITYOf CONSTRUCTION everett PERMIT 9UILDING DEPARTMENT 359.8745 TO BE COMPLETED IN INK • PLEASE PRINT 7 DEMOLITION ❑ COMBINATION A R BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN WNERMAIL ADDRESS CRY ZIP PHONE RCHItECf ORO SIGNER MAIL ADDRESS LILY ZIP PHONE LITERAL CONTRACTOR MAIL ADDRESS City ZIP PHONE LICENSE of -77g', T�E Er Jv/ '•/�Jr' FuIj cc ��♦. ci SG /[1T. 7=C7F/1i IF.CHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE LUMBINOCONIRACtOR MAIL ADDRESS CITY SIP PHONE LICENSE• 1ASSOF WORK �y NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION LLUAtIONOF WORK 10091 OF MATERIALS PLUS LABOR; F 9C4 WORN + wu � ! Y • r A It Gf BUILDING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL GAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR At TACT(FOUR COPIES; PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- It 2 ERE•It2 BLOCKL OF ` /� 4 IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TIIE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNAtURE Of CONTRACTOR OR AUTHORREO AGENT DATE IOJECT ADORE 99 APPLICAN T 9 Cl T Y 80§1 HE SS LICE NSE NO A. ✓- LUMBING MECHANICAL _ NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FEE WATER CLOSET TOILE AIR COND. UNITS-HP.EA. BATHTUB REFRIGERATION UNITS-H.P.EA LAVATORY IWASH BASINJ BOILERS-H.P.EA _ SHOWER OAS FIRED AC UNITS-TONNAGE EA KITCHEN SINK A DISP. FORCED AIR SYSTEMS-B.T.U. M EA. DISHWASHER WALL;/EATERS-B.T.U. M LAUNDRYTRAY UNIT HEATERS-B.T.0 M CLOTHES WASHER EVAPORATIVE COOLERS _ WATER HEATER _ CLOTHES DRYERS URINAL VENTILATION FAN DRINKING FOUNTAIN RANGE 11000 FLOOR DRAIN AIR HANDLING UNIT- C.F.M. VACUUM BREAKERS STOVE ROOF DRAINS-RAINLEAOERS METAL FIREPLACE A CHIMNEY SINK SERVICE-•BAR,ETC.I WOODSTOVE/FIREPLACE INSERT BUB TOTAL BUB TOTAL A PERMIT B PERMIT A _ TOTALFEE A TOTAL FEE f THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL TNT SEISACX REAR SE TRACK SIDE SETBACK -R—AN-CHECK NUMBER �� PLANCHFCKFEE IV')IdUs. FEE {// RECEIPT NO 4 QQ35 F.20NE LOT ARFL)EA VACANT SHE FEES VALUATION i!! DYES ❑NO Il OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS 156 BUILDING f 'E OF BLDG NO OF STORIES MAX OCC LOAD PLUMBING MECHANICALle co HE SPRINKLERS REQUIRED O YES O NO OTHER PENALTY I'LICAIION ACC BY PLANSC14ECKEDDY APPR FOR ISSUANCE BY - TOTAL �