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A`iwPLICATION FOR`d <br />CAP EYsrprwen CONSTRUCTIONCITY OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT <br />A <br />299'87,15 glYCOMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />C/��tiiN flohrt' <br />MAIL ADDRESS <br />7/7 <br />- -- CITY <br />5.6. Eue/Le,T 14A4// <br />ZIP <br />ur <br />RIONE <br />3-Gs'o <br />ANCIO I ECT OR OEBIONTII <br />MAIL ADDRESS <br />CITY <br />ZIP <br />RIONE <br />,orvnR¢17 <br />OE NE DAL CONTRACTOR <br />MAIL ADDRESS <br />v7 e. * S 14hoo'.t- <br />CITY <br />ZIP <br />R'ONE LICENSE. <br />CR-y.y-// VAltl Da <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />.CITY <br />21P <br />PHONE LICENSE. <br />PLUMBWOEONTRACIOR MAR ADDRESS CITY ZIP RIONE LICENSEE <br />.WAIEW ❑ ADDITION ❑ ALTERATION ❑ NEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ DUILDINO RELOCATION <br />VALUAI�IUTI Or WORKICOST Of MAIER01L5 PLUS LAB091 <br />70 to/2 <br />DESCRIBE WORK <br />6, - <br />USE D' PUILOINO <br />S,.or, /e, + 1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONANDKNOWTHESAME TOBETRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETED WITH WIIETHERSPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT 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 AUTHORtiED AGENT DATE <br />X .7 - lc'%5� <br />IEL:AL IIESCRIPTION Of PROPERIYISHOWN BElO ORATTACNF 6FIESI <br />q �f 1'Gf/ <br />IGILBLOCK—OF <br />PIIW[CI tDUaIIUS <br />-,9L35i O fy L. ex et.7 <br />APPL 'ANTSCIIYBUSINESSLI 'N NO <br />PLUMBING <br />MECHANICAL <br />N0. <br />_ <br />TYPE OF FIXTURE <br />_ FEE <br />NO. <br />TYPE OF EQUIPMENT _ <br />FEE _ <br />WATER CLOSET (TOILET) <br />v� <br />AIR COND, UNITS-H, P. EA <br />�- <br />BATHTUB <br />Co <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY IWASH BASIN <br />dG <br />BOILERS—H.P. EA <br />l <br />SHOWER <br />00 <br />OAS FIRED AG UNITS —TONNAGE EA _ <br />/ <br />KITCHEN SINK A DISP. <br />lz <br />OCT <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />/ <br />DISHWASHER <br />00 <br />WALL HEATERS—B.T.U. M <br />O <br />LAUNDRY TRAY <br />_t <br />UNIT HEATERS—B.T.U. M <br />IFCLOTHESWASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />URINAL <br />1 CLOTHES DRYERS <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE H000 <br />VIP — <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />HOOF !RAINS—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR. EIC.1 <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />O <br />SUBTOTAL <br />_ <br />PERMIT A <br />PERMIT <br />TOTAL FEE S <br />Zt. <br />LIA <br />TOTALFEE A <br />THIS PORTION TO E COMPLETED BY EUILDING DEPT. PERSONNEL <br />FROM StSr ,RACK <br />(r <br />NLAR SETBACK <br />ZC) <br />SIDE Sr U1ACK <br />Y/O <br />PLAN CNer:w uMPen <br />FS'5 �S/O <br />•-^• <br />`�Z54. L <br />—•--- -- <br />REr. P �Q <br />USE IOrIi;.'/ <br />LOT AREA <br />VAC! <br />ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE ORR441ISI <br />a -A/ <br />OCCUPANCY GROUP/ <br />R 3 1M• <br />NO.OFOY LUNGUNHS <br />BUanwG <br />F - <br />3 <br />O <br />Rlir Or moo <br />o+4DV <br />OF BRIDES <br />NO <br />MAX DOC LOAD <br />[/A <br />PLUMBING <br />VCj <br />FIRE SPRINKLERS RLOUIRL'D ❑ YES B'f'j0 <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />ICY <br />PUNB CIIECNEO BY <br />de <br />APPR iORISSUANCE BY <br />r E <br />TOTAL <br />