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6p5 I C I C r <br />A,F[eBAA APPLICA i ION FOR <br />IITY(.F CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O-COMBINATION ❑ BUILDING ❑ MECHANICAL <br />OWNER MAIL ADOR 86 CITY SIP <br />0 PLUMBING O SIGN <br />P_Em =4 loc. 4Z9 1 Izt),b g&y Cvezwn- ` g r 2 5 2-,11*V <br />ARC.I..ECf OR O[SIOI.ER ��: -_MAIL ADDRESS CI r <br />ZIP PNONE <br />MECIIANICAL CONTRACTOR MAIL ADDRESS CIFY ZIP PHONE LICENSE• -• <br />PLUMBING CONTRACTOR MAIL ADORESS CITY ZIP PHONE LICENSE <br />:LASS OF WORK <br />9—NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />L 4-11 T7T-ALJ. <br />11[3[.[IINf WUIIR [ <br />usE or eunnwD <br />/� <br />SILk(IL� IL_�! l_ ErII�(�J <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND 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 AUT14ORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON TMCTOR OR AUTHORIZED AGLNT DATE <br />X <br />LEaAL DEBcmpnexar'rTroPERrruNGWN nElow on Ai TACIl roan corxsl <br />mow= 9LOCK__or <br />• - - <br />PROJECTADDRE 9 " <br />�.. �0 o)., '^)g E <br />APPLICANTS Cl IV BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE Of FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />jl,�10 <br />AIR COND UNITS-H P. EA <br />BATHTUB <br />b <br />NEFRIGERAT10N UNITS-H P. EA <br />_ <br />_ <br />LAVATORY IWASH BASIN( <br />==tl,f <br />PC <br />BOILERS_H P. EA <br />I <br />SHOWER <br />L <br />fJ C <br />OAS fIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A OISP. <br />a <br />D <br />FORCED AIR SYSTEMS-0 T U. M EA.— <br />--I- <br />DISHWASHER <br />WALL HEATERS=B T.0 M <br />LAUNDRYTRAY <br />_ <br />UNIT HEATERS-B I M <br />_ <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />I <br />WATER (HEATER <br />I <br />CLOTHES DRYERS <br />S"O <br />URINAL <br />VENTILATION FAN <br />90 <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL 1IREPLACE S CHIMNEY <br />SINK SERVICE -BAR ETC.1 <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />—'LL�3 <br />SUBTOTAL <br />PERMIT / <br />PERMIT 1 <br />TOTAL FEE <br />�� <br />TOTAL FEE i <br />_ <br />t Cl <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PVC)..,.,"',. <br />USE P ZONE <br />— I <br />IG <br />LOT AREA <br />VACANT SITE <br />OVER ONO <br />f[[S <br />TYPE Of COUST <br />v-- 0 <br />OCCUPANCY CROUP <br />r2- 3 <br />NO Of DWELLING WIITS <br />I <br />BUILDING <br />BITE OF OL DO <br />(enV— TZ.� <br />NO OF $1DRIES <br />MAX OC <br />AJ.1-. <br />(GAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />MECHANICAL <br />0111ER <br />PENALTY <br />APPUCAHONACC BY <br />//�'�/ <br />PLANS CHECKED BY <br />C`� .�/}[/y,� <br />APPR FON ISSUANCE BY <br />/, %� <br />TOTAL <br />RECEIPT NO <br />VALUATION I FEE <br />