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APPLICATION FOR <br />file CITY <br />CONSTRUCTION <br />clrr of <br />everett PERMIT <br />To. BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION A BUILDING ❑ MECHANICAL <br />OWI MAIL ADDRESS CITY ZIP <br />x@pnF AJZ/ /i/FT•1IH '1_u.-ch17 Ilb Jl vi DI I.I Ifill, / %u"rT .O� <br />ev[reN <br />❑ PLUMBING ❑ SIGN <br />M.ONF <br />m1liNT(A1Z <br />GENERAL CONTRACTOR <br />MAILADDnE89 <br />CITY <br />ZIP PRONE <br />LICENSE• <br />511hL($ <br />Q R-OU-II +ZI41 <br />MECRANICAL CONTRACTOR <br />MAIL ADDRE99 <br />CITY <br />ZIP roo,jr. <br />LICENSE• <br />5 gthr <br />)COMBING CONTRACTOR <br />MAIL AODIIE99 <br />CITY <br />SIP MIONE <br />LICENSE <br />sairr <br />CLASSOr WORM <br />❑ <br />PI NEW ❑ ADDITION ❑ <br />ALTERATION ❑ <br />REPAIR ❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT <br />BUILDING RELOCATION <br />VALUARON Or WORK ICOST Or MA I I 111^19 PLUS LAnODI <br />USE OF BUILDINa <br />Slu ' — 16mr <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERN'NG THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SF .CIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NO1" PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL OESCnIPTM)N Or PROPERTY ISROWN BELOW OR ATTACH rCURCOPIESI <br />n <br />LOT1rLOCK_Or M1111117A V115111 I <br />-" <br />PROJECTAODFESS <br />L913 8qps.t Sr, 2U <br />APPIIC CIIYBUSINE9SLILEASF NO <br />/id z5 _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />OD <br />AIRCOND.UNITS—H.P.EA. <br />—_ <br />00 <br />REFRIGERATION UNITS—H.P. EA <br />_BATHTUB _ <br />LAVATORY WASH BASIN <br />00 <br />_ <br />BOILERS—H P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP, <br />0 <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />LAUNDRY TRAY <br />g <br />QO <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS-B.T U. M <br />CLOTHES WASHER <br />WATER HEATER <br />C2 <br />JO <br />OQ <br />_� <br />_ <br />EVAPORATIVE COOLERS__ <br />CLOTHES DRYERSjo <br />URINAL <br />VENTILATION FAN <br />c0 <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />el <br />5-0 <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_91 <br />VACUUM BREAKERS <br />ROOF DRAINS- RAINLEADERS <br />_ <br />_ <br />—J� <br />STOVE _ <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />_ <br />SINK SERVICE -BAP ETC. <br />0 <br />WOODSTOVEJFIREPLACE INSERT <br />SUB TOTAL <br />0 <br />BUB TOTAL t <br />0 0 <br />_ <br />PERMIT t <br />_ <br />PERMIT t <br />_ <br />TOTAL FEE of <br />_ <br />J <br />TOTAL FEE t <br />pC <br />THIS POI;TION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK ` <br />420 <br />REARSEIBACK / <br />—�1 O <br />SIDE SCIOACK / <br />PLAN CHECK NUMBER <br />J 1 zoo � / <br />PLAN <br />FIF `C- <br />CI.ECK FEE <br />RECEIPT NO <br />USE ZONE <br />— / <br />LOI AREA <br />VACANT ,SITE <br />j�1'F8 ONO <br />iEFE <br />VALUATION <br />f[! <br />"FIE OF LI.NSI <br />UUCUPANCY GROUP <br />NO OF DWELLRIG UNITS <br />NUILDING <br />PLUMBING <br />f�zg 0Q <br />J <br />3(0 <br />00 <br />00 <br />SIZE OF RI DO <br />uO UI SIOnIES <br />MA I OCL LOAD <br />FIRE SPRINKLERS REQUIRED OYES ANO <br />MECIUNICAL <br />--I <br />on1En <br />PENALTY <br />APPI ICARON ACC BY <br />PI AN S CII ECKE D BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />dB 9 <br />0 <br />