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IAlEIIFpTNR r _ &PPLICATION FO.�' evert" <br /> GHYOF CONSTRUCTION <br /> everett PERMIT <br /> BUILD114G DEPARTMENT <br /> 258.8745 TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER \ MAILArDRE89 GITY ZIP PHONE <br /> f)AVin E. N1114 luk- 7n +bOk► 4-- mgrl-T gi?,h3 3s-�?—(D/-130 <br /> ARCHITECT OR DESIONER MAIL ADORF99 CITY ZIP PIHONE <br /> GENERAL CONTRACTOR AIAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> I <br /> M.CHAIOG R MAIL ADDRESS OIT1' ZIP PHONE LICENSEA <br /> PLUMBINGCONTPACIOR MAIL ADDRESS CRY ZIP PHONE LICENSE• <br /> CLASS OF WORK <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VALUA,7d j T �9IOMATERIAL%PLUS LABGRI <br /> DESCRIBE WORK <br /> 1 f 1 L <br /> USE or sulLnlNa I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AID. <br /> FS = I C = PLICATIONAND KNOWTHF SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION Or PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT—BLOCK— IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SION UBE Or CONTRACTOR OR AUTHOnIZED AGENT DATE <br /> Z <br /> J <br /> c - <br /> PROJECT ACIDNESS ` APPLICANF9 CITY BI NE 99 LICENSE NO <br /> 10;4-7 1h $F uy a 9 71- <br /> PLUMBING _ MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EOUIPMENT FE[ <br /> WATER CLOSET ITOILETI AIR COND.UNITS-H.P.EA_ <br /> _DATHTUB REFRIGERATION UNITS-M.P.EA. <br /> LAVATORY WASH BASIN BOILERS-H.P.EA <br /> SI;OWER OAS FIRED AC.UNITS-TONNAGE EA _ <br /> KITCHEN SINK&DISP, FORCED AIR SYSTEMS-B.T.U. MEA <br /> DISHWASHER WALL HEATERS-B.T.U. M _ <br /> LAUNDRY TRAY IINITMEATERS-B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD _ <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE A CHIMNEY _ <br /> 61NK SERVICE-BAR,EIC.1 WOODSTOVE/FIREPLACE INSERT <br /> SUE TOTAL SUBTOTAL f <br /> PERMIT E _ PERMIT E <br /> TOTAL FEE i TOTAL FEE $I- <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT BE MACK REAR BE TRACK BIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br /> FEE RECEIPT NO <br /> USE ZONE LOT AREA VACANT SITE <br /> FFlB VALUATION Fl! <br /> OYES ONO <br /> PIPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> BUILDING S <br /> SIZE O/BI no NO OF STORIES MAX OCC LOAD <br /> PLUMBING <br /> MECHANICAL <br /> FIRE SPRINKLERS REOUIRED O YES O NO <br /> OTHER <br /> PENALTY <br /> APPH ICATION ACC BY PLANS CHECKED BY APPR FOA ISSUANCE BY <br /> TOTAL <br />