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I <br />IBB EYBrpTBBn ..PPLICATION FO'..' EYPTPR <br />CITY OF CONSTRUCTION n <br />everett PERMIT �J <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />' I <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />i O"JIIER — ----- MAIL ADDRESS CITY �IaBaoj PHONE <br />.��5 ; � ds. w. cveR�n c�AsA• �s'3 -.� S9G <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICEN! L IF <br />PLUMBINGCONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />RPNEW 1: ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAVIATIONOFWORKICOSIOr MAIrnMLSPLURLAPOM _ru <br />DE SCRIBE WORK <br />D BUILDING / <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNO'NTHF.SAME TOBETRUE ANDCORRFCT.ALL <br />PROVI'310NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BF COMPLETED WITH WHETHER SPECIFIED HERE. <br />INORNOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANYO HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL OE NPT1ON Pi PROPERTY (SHOWN BE WOR TTACNFOURCOPIEM <br />-�- <br />LOT BLOCK _^r �9iJ9 $E� <br />126er Ay� <br />PROJECT ADDRESS <br />APPLIC TB CITY BUSINESS PCENSF No <br />PLUMBING <br />MECHANICAL <br />NO. <br />_ _ <br />TYPE OF FIATURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOIL" <br />lS <br />00 <br />AIR COND. UNITS—H.P. EA <br />_ <br />BATHTUB <br />S <br />w <br />REFRIGERATION UNITS—H.P. EA <br />-_ <br />LAVATORY WASH BASIN) <br />BOILERS—H P. EA. <br />SHOWER <br />QV <br />OAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK A DISP, <br />It" <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />1 <br />DISHWASHER <br />LAUNDRY TRAY <br />WALL HEATERS—B.T.U. M 2,FA0 O <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />6 <br />C%J <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />S� <br />URINAL <br />VENTILATION FAN <br />D?mIeING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />_ <br />VACUUAIBREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE —BAR ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />wn � <br />SUB TOTAL <br />S�- <br />SUB TOTAL B <br />'U <br />PERIAIT B <br />PERMIT B <br />TOTAL FEE • <br />_ TOTAL FEE B <br />�� <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />nEAR BETBACK SIDE SETBACK PLAN CHECKNUMBER IPLAN CHECN <br />oTOZ UJ �, <br />USE ZONE LOT ACR�EA VACANT SITE <br />/1 —I a4 /'T f)S ONO <br />7 <br />V� <br />I �, _ J <br />I F <br />BUILDING <br />STORIES <br />MAX OCC LOAD <br />PLUMBING <br />O YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />CHECKED BY <br />APPn FDA ISSUANCE BY <br />TOTAL <br />FE I RECEIPT NO <br />rCJ T � anti. <br />FEES VALUATION FEE <br />[iUCA'1 u-le! <br />MOM <br />AT <br />