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k�PPLICATION FGF. <br /> CITY OI PIr1I <br /> C.O N ST R VI C T;i O N <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK— PLEALIE PRINT <br /> BUILDING DEPT. <br /> 25E9-8745 ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS city Zip PHONE <br /> G / _ 71L I/ .. ±A lr ��G •r-• 'i• L'i ? :'gt rI'•id <br /> / • PHONE <br /> ARCHITECT OR DESIGNERMAII ADDRESS CITY 2R <br /> T.rT <br /> GENERAL CONTRACTOR / MAR ADDRESS CITY ZIP PRUNEIK:ENSE <br /> Z?A ltcn z f,r /L. r-Z r'rs •1,(•JA:. )N/ <br /> MECHANICAL CONTRACTOR MAR ADORES! CITY ZIP PHONE UCENSE F <br /> PLUMBING CONTMCTOR <br /> MAIL ADDRESS CITY lip PRONE LICENSE IF <br /> CLASS OF WORK <br /> ZI NEW ❑ ACOITION ❑ ALTEPATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLINSERT BUILDING RELOCATION_ z0 <br /> VALUATION Of WORK( OF MATENIALS PLUS LASOFS <br /> r•y <br /> m <br /> DEBI;RIBE WORK <br /> C -•- [ /1�E Ir r-r <br /> USE OF BWL TNG � T <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATIONANO KNOW THE SAME TOBE TRUEAND CORRECT.ALL <br /> ZEAL OF/POPERTY I?MOWN BELOW OR ATIACHFOURCOPEM PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE om <br /> n OF WORK WILL BE COMPLETED WITH WHETHER SPECIFICD HERE- <br /> LorrjC—BLocK--oF �' '• IN OR NOT.THE GRANTING OFAPERMITDOESNOTPRESUMETO m� <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION o <br /> OR THE DERFORMANCE OF CONSTRUCTION. z <br /> SIONATURL OF CONTRACTOR OR AUTHORIZED AGENT DATE 32 <br /> m~ <br /> A{•I'LIcANrB Ol y BUSINESS UCENSE NO <br /> PROJECT ADORES! N <br /> II 7/7i L e,,- <br /> PLUM No <br /> /PLUMEINo _- kMECHANICAI NO. TYPE OF FIXTURE FEE TYPE OF EQUIPMENTFEEWATER CLOSET TOILER AIRCOND.UNITS-HPEABATHTUB REFRIGERATION UNITS-H P — <br /> IOUBOILERS-11 P.EA LAVATORY WASH BASIN C LnSHOWERQ'JOAS fIREO AC UNITS-TOfINAGE EA 3 KITCHEN SINK 6 OISP. FORCED AIR 9YS7EMS-BTU MEA_- <br /> D19HWASHER BWALL HEATERS-BTU. M • m <br /> LAUNDRY TRAY UNIT HEALERS-B T.U. M Y <br /> / CLOTHES WASHER <br /> EVAPORATIVE COOLER5 _ A <br /> WATER HEATER <br /> CLOTHES DRYERS ~ <br /> D <br /> VENTILATION FAN z <br /> URINAL O <br /> DRINKING FOUNTAIN RANGE HOOD -i <br /> AIR HANDLING UNIT- CF.M. x <br /> FLOOR DRAIN <br /> VACUUM BREAKERS STOVE <br /> ESINK <br /> -RAINLEADERS METAL FIREPLACE 8 CHIMNEY Z <br /> WOOOSTOVE/FIREPLACE INSERT o <br /> -SAX ETC <br /> r <br /> IN-- <br /> m <br /> SUBTOTAL ,__ SUBTOTAL ! <br /> PERMIT E -- -- <br /> PERMIT E <br /> TOTAL FE! [ _ -_ _ _. _ _.__._ - _. TOTAL FEE E <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> 1KAlILIILCN IEE <br /> FRONT SETBACK REAR SETBACK SIDE SETBACKPLANCHFC NUMBER FEE G� RECEIPT NO <br /> Q L//CC��^1///// y� 3 •fes b!6 <br /> USE ZOrL(_I LOT AREA V?NT SIZE FEES YAlVAt10N FF[ <br /> AA(�ii/J QYE! ONO <br /> TYPE OF CONST OCCUPANCY GROUP ND JF DWELLING UNITS �— <br /> BUILDING E-77—",V' 3 L9 D <br /> SIZE OF BLDG NO.OF STORIES MAX OCC.LOAD PLUMBING & D <br /> ME <br /> EE- J!,1 <br /> CHANICAL <br /> FIRE SPRINKLERS REQUIRED O YES O NO _ OTHER <br /> PENALTY _ <br /> APPLICATION ACC BY PLANSCHECKEDBY APPR FOR FOSSUANCE BY I 5a <br /> TOTAL <br /> L . G . ..J�'F L• G <br /> _ I <br />