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L APPLICATION f0'h..! <br />cF,[FPR <br />CONSTRUCTION <br />CITYtyuOrF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION A BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADORES! City ZIP ON <br />-Rn hP, rf E. TIJ.L'A AIrie . /4f 4lO , - i(2AI /71 AIDE al. . vdIAt eeo i O <br />0 r 10A//((_ /7,olr /JhWr- /NC/ 27 a44Y /A(W C0 00 7' PO. rb'rx IS SEAR nitvw Al. j' //So <br />GENERAL C04TAACTOII MAIL ADORED! CITY ZIP PHONE VCENSEA <br />MECIIANIGAL CONIDACTOR MAIL ADORE!! CITY ZIP PHONE LICENSE <br />c-A11E2 C 0 N�.7a� To a6 .�SJ'iG o <br />PLUMNIIIn CONtRACIOR MAIL ADDRESS CITY ZIP PRONE II[FUA,. <br />Cl1i!!0 <br />E WORN <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODS70VE/FRPL.INSERT ❑ BUILDING RELOCATION <br />.GEiJ fl)W) !--WAI"k HeusJr <br />USE OE BUnILDING OAIE — 51,416E E fAMI X <br />L/ A�s7g,,s/L/r1AZ_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT.ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REG ULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIONATU:IE or CONTRACTOR on AUTHORIZED AGENT DATE <br />LEGAL DESCRIPIIONOF RDPEFHY(SHOWN BELOW OR ATTACH EMIR DOPIEST <br />' <br />Lot Bloc _oF_rFi�F./IE°1As� ��L'��I� <br />Eve ^e�` 02 eN.W." AS <br />/I /� <br />')dlr&4 Em EPA gi-IS J I aPC Q4S-1 vere //1 . <br />PROJECT ADDRESS .///— V0 + OG SE• <br />EdctEzr, wA. 9?20c <br />APPLIC/RYS CITY BUSINESS LICENSE NO <br />PLUMBING <br />_ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />19 <br />BU <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />-7V <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY WASH BASINI <br />BOILERS-H.P. EA <br />61E0WER <br />OAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP, <br />57 <br />FORCED AIR SYSTEMS-B.T.U. M EA McJ� <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY10 <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES V,ASHER <br />n <br />I EVAPORATIVE COOLERS <br />WATER HEOJER <br />CLOTHES DRYERS <br />Tom, <br />vE„J <br />G <br />URINAL <br />VENTILATION FAN <br />O <br />DRINKING FOUNTAIN <br />RANOP HM dkrw Fd A lA FYNu YF Af <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />TOVE <br />ROOF DRAINS-RAINLEADERS <br />MEtAL FIREPLACE B CHIMNEY <br />O <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPLACElNBERL /�au <br />Jo'7�7L <br />BUD TOTAL <br />BUD TOTAL E <br />PERMIT B <br />PERMIT B <br />TOTAL FEE • <br />(JCJ <br />TOTAL FEE e <br />THIS PORTiON TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REARSEIBACKI SIDE BET13ACK PLAN CHECK NUMBER PLAN CHECK FEE <br />%7• I J T p/ FEE 7 /��L RECEIPT HO <br />LOT AREA VACANT SITE O Y� JA U <br />FEES VALUATION F[[ <br />. / ..I tea ONO __ <br />E OF CONST <br />OCCUPANCY GROUP <br />NO OF OWELLRH <br />T-/4 <br />R-? <br />/ <br />E OF BLDO <br />NO OF STORIES <br />MAX OCC LOAD <br />wo , I JAG I t_. c. <br />BUILDING <br />F <br />ev-10SZ <br />PLUMBING <br />Q <br />VU <br />MECHANICAL <br />T <br />(J <br />OTHER <br />PENALTY <br />TOTAL <br />J 0 <br />? - <br />