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IAB EYFfBEFFR AE'PLICATION FOR EYlIlR <br />CITY OF everett CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259•8745 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS <br />I-I-J, uJ I' / , Lit/c.l /j c,-e <br />CITY ZIP PII011E <br />G-r v�-, 4,0kC1 y&. W.y 'i i' ��'r, <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />ITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />L A .ICi(./</e. S•7A...r <br />CITY ZIP PHOIIE LICENSE, <br />(I/97L,U <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONL LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS c <br />,.I . , ., ,�:..� /,� � ) 1+' <br />C,f. ZIP PHNNL HCEIILE0 <br />< <br />ref / �;..�I t< •r LYA � y�.>: •i 't > >->i�Gi�/ <br />CLASS Of WORK <br />B ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />1 <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABORI <br />DESCRIBE WORK <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO FIE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITHWHETHERSPECIFIEDHERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGN f TURF OF CONTRACTORORAUTHORIZEUAGLNI DATE /-✓�'aO <br />LEGALDESCRIP IONOFPROPERTY ISHOWNBELOW ORATTACH FOUR COPIESI <br />Lot—eLocR_oF A•1), L�,A%4• r<• <br />PROJECTADDRESS <br />_, l !,•y �—� Qfl Nei 6,9 <br />APPLICAN TB CI TY BRSINE 95LICE NSE NO <br />BIND <br />MECHANICAL <br />_PLUM <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET TOILE <br />lhao <br />AIR COND UNITS-H P. EA <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY WASH BASIM <br />GO <br />BOILERS-41 P. EA <br />_f <br />SHOWER <br />Q <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />/ <br />KITCl/EN SINK! DISP. <br />i <br />FORCED AIR SYSTEMS -BTU <br />/ <br />DISHWASHER <br />WALL HEATERS-B <br />I AUNDRY TRAY <br />_ <br />UNIT HEATERS-0 I.U. M <br />_ <br />CLOTHES WASHER <br />(i0 <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />f <br />CLOTHESDRYERS <br />URINAL <br />I <br />IVENTILATIONFAN <br />RANGE HOOD <br />Oro <br />_DRINKING _FOUNTAIN <br />DRAIN <br />AIR HANDLING UNIT- C F.M. <br />_FLOOR <br />VACUUM BREAKERS <br />STOVE <br />_ <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL F'IREPLACE a CHIMNEY <br />#INK ISERVICE-BAR ETC.1 <br />WOODSTOVE/FIREPLACE INSERT <br />BUB TOTAL <br />DO <br />BUB TOTAL <br />PERMIT <br />PERMIT • <br />_ <br />TOTAL FEE <br />_ <br />TOTAL FEE • <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />(HONTBEISACR I <br />UBE z"'A , <br />)' I <br />TYPE Of CONST <br />1 <br />611E OF B10G <br />2. <br />REAR BETBACR <br />1• <br />SIDE SETBACK <br />' ,1 LYf <br />PLAN CHECK NUMBER <br />PI AN <br />FEE ��� <br />CHECK fit <br />CurlNG -1 <br />FBI <br />u <br />) �- <br />A 00 <br />LOT ARE `/ <br />/A ar <br />VAC T 011E <br />OYES ONO <br />P!L! <br />VALUATION <br />OCCUPANCY GROUP <br />S - <br />NO OF DWELLING VNIT8 <br />/ <br />BUILDING <br />8 to <br />NO OF GLORIES <br />.511 / / - cFI/FL, <br />MAX OCC//LOAD <br />h <br />PLUMBING <br />- <br />MECHANICAL I <br />FIRE SPRINKLERS REOUIHED ❑ YES N NO — <br />OTHER <br />PENALTY <br />AVPLIG110N ACC BY PLANSCHECKEDBY APPR IORIBOUANCH BY ----- - <br />j tout -- - - - <br />0 <br />