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Me Er�iOreen �A P�L I C�A T I O N F O R <br /> ��TMOF C� P RM�TTfON eV� <br /> everett <br /> BUILDING DEPARTA4ENT <br /> 259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> O LEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OYMER MAII A�ORESS CI(V ZIP PIIONE <br /> %I�s�R 5 �R��G�✓�l s<: r�ed. l3.t,� l d a / /�/�fr��,..�r n/� Sca>>i� qg�.E �f�so v <br /> ARCI ItECiORpES NER M LADORESS CI. 21� PHONE <br /> s�ar �,'�N; �� � �`��, �r,�weo � �y� yG y/ <br /> GENERRLGOJfFACtOP MAL ODRE55 CIiV .IP P��ONE LICENSE• <br /> MECNANIGALWNiPTLiOA MAILRDORE55 LILY ZIP MIONE LICENSE� <br /> PWMBINGCONTRACTOR l.IAILA�OR[55 CITY 11P PIIONE U:E!!SE• ', <br /> CUSS OF WORK <br /> ❑ NEW ❑ ADDIiION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VnLUnLION OF WORK�COSL Of M1UiEFIqLS P�US LABOHI -__ <br /> � p m�p O ol <br /> pE5CRi0E WORN <br /> G N�✓i�N% /M f'/z o J a nn e,✓ i '--- <br /> useorem�mrvc <br /> �i 5 y �a 2 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi.ALL <br /> IF�RLDESCRIPi10NOFPRQPEFiY�SHOWNOELOWOflAiTALNFOUqGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED FiERE- <br /> ior._,eioc�_ov IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> s'� G ,r��/�.c l� pI GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS C� <br /> ANY OTHER STATE OR LUCAL LAW REGULATING CONSTRUCTION <br /> - �,^� OR THE PERFORMANCE OF r,ONSTRUCTION. <br /> SIGNATUIiE OF GONiqACTOR OR AU7nORIZED AGENT OATE <br /> ♦ / <br /> X �/�lil�✓1-c--. C ' - 7/�,/�—f� <br /> PROJECiA0DRE55 <br /> APFLICRNiS CItY BUSINESS LIGENSE N <br /> / 5 2 v . y l,�' /�veP.e r� t�n.) �1 h 2 � 3 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUflE FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEq CLOSET�TOILET) AIR COND. UNITS—N.P.EA. <br /> BATHTUB REFRIGERATION UNITS—H.P. EA. <br /> LAVATORY�WASH 6ASIN� �OILEFS—H.P.EA. <br /> SHOWER GAS FIRED AC. UNITS—TONNAGE EA. <br /> KITCHEN SINK 8�ISV. FORCED AIF gY5iEM5—B.T.U. M EA. <br /> _ DISHWASHER Wr11.L ,._ATERS—B.i.U. M <br /> _ LAUNDRY TRAV UtJ1T HEATERS—B.T.U. M <br /> CLOTHES WASHEq EVAPOf7A71VE COOLERS <br /> WATEP HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DFINKING FOUNTAIN RANCE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREFKEHS STOVE <br /> _ FOOF DRAINS—RAINLEADERS METAL FIflEPLACE 8 CHIMNEY <br /> SINN�SERVICE—BAR,ETC. WOODS�OVE/FIREPLACE INSERi <br /> _ SUBTOTAL _ SUBTOTAL S <br /> PERMIT S PEfiM1T 5 <br /> _ TOTALFEE 5 TOTALFEE 5 <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FqONT SEiBALK RERR SEIBRCK SIDE SEiBACK PLAN[C�H[EC�K lABEti P�AN Cu[CH fEE <br /> X lU I in5�3 FEe ��7�r neeerr No >p/ ( J <br /> USE20NE LOiAREA J � � <br /> V�CANTSITE FEES VALIIAtION fEE <br /> OYES ONO <br /> TVPE OF CONST. OCCUPRNCY GfiOUP NO.OF DWEL�ING 11NII5 <br /> BUILOING S <br /> SIZE OF 8�00. N0.OF SiOBIES MAR.00C.LOAD <br /> �'�UM�ING <br /> MECMANICAL <br /> FIRE SPRINKLERS REOUIRED ❑ YES ❑ NO . _ <br /> 07HER <br /> PENACfY <br /> APPLICAIION PCC.BY PL4N5 CIIECHEO BY �PCR.FOR ISSU�NGE BY � <br /> � � TOTRL <br /> / <br /> � <br />