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TAB EYBrpITrBrI <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />DEMOLITION <br />PPLICATION FO.) <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />COMBINATION <br />❑ BUILDING ❑ MECHANICAL <br />O PLUMBING <br />❑ SIGN <br />I FILL. <br />CITY OF EVE(2ETT <br />_...-.__ <br />3002 w5rr Aovx <br />F-VEJ-7ETT <br />9820 1 <br />Z59 vsil <br />ARCHITECT OR DESIGNER <br />S�GOZLOVSKI <br />MAIL ADDRESS <br />3002 WFrlA0 r <br />CITY <br />EvERriTT <br />ZIP <br />9220( <br />PHONE <br />259 8811 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP <br />PHONE LICENSFc <br />RUMBINGCONTPACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION <br />DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />;;NONOF WORN(^AST GF AIML RIALS PLU9 LABDRI �l /CNp / fSL-ocn •E <br />Wool L(oh eAlstl' Malls lus}alI A ors u�T=�uTeY pOO�s R- <br />GEscRIBEwoRN Q <br />LlTcS. SWITCtY-_5 4A kr-L.1fWO �)arlCllCC1WQ-4 tDlle 1'Z1000 <br />drat. <br />ALTERATION ❑ REPAIR <br />USE Of BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />MUw(r-If AL <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TI IIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />OF VYORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BLOCK __OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />\ <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />NOPKINS BLDG.J 1/200 <br />S028 WErMOF C <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OP THE PERFORMANCE OF CONSTRUCTION. <br />1. �T <br />EVF_FtE T TpI 1M . 1 S Zc) I <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X n t -_ -23-SQL <br />PROJECT ADDRESS <br />APPLICANIy YtlUSWEBB UCENBE NO. <br />do. 2)cas <br />/LUMII'(O <br />MECHANICAL <br />NO. TYPE OF FIXTURE FEE <br />NO. <br />TYPE OF EDUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR COND UNITS—H.P. EA. <br />REFRIGERATION UNNS—H. P. EA. <br />_BATHTUB <br />LAVATORY (WASH BASINI <br />BOILERS—H. P. EA. _ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />` <br />KITCHEN SINK 1 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />_J <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />IJ <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />_ <br />METAL FIREPLACE d CHIMNEY <br />SINK (SERVICE —BAR. ETC. <br />_ <br />WOODSI OVE/FIREPLACE INSERT <br />SUBTOTAL <br />() <br />SUB TOTAL f <br />PERMIT <br />PERMIT 1 <br />_ <br />TOTAL FEE <br />TOTAL FEE IT <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING DEPT. PERSONNEL <br />IBONT SETBACK <br />REAR SCIBACK <br />N. A <br />f� <br />SIDE SET BACK <br />PLAN CHECK NUMDER <br />(� �� <br />If 1[I <br />FEES <br />PLAN <br />FEE <br />VALUATION <br />CHECK I EE <br />RECEIPT NO <br />FEE <br />1 <br />USE ZONE <br />rJ <br />LOT ARIA <br />/A ' <br />u <br />VACANT SITE <br />AYES O <br />1 <br />S O <br />TYPE OF CONST <br />l W( <br />OCCUPANCY GROUP <br />% r,-*L <br />NO O! DWELLING UNITSAli, <br />BUILDING <br />iIZE O! BLD a <br />LGJ,v✓ <br />110 OT SipRIES <br />MAX OCC LOAD <br />PLUMBING <br />_ <br />7 <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED <br />L7 YES O NO <br />OTHER <br />PENALTY <br />APPI ICATION ACC BY <br />Pl'.NS CHLCKED BY <br />APPR lOR 155UANOE BY <br />TOTAL <br />IL 3J <br />