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PPLICATION FOw.atho <br />CIFYOF "° CONSTRUCTION <br />CRT OF <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS I` CITY ZIP PHONE <br />^ <br />ARCHHE CT ROESIGNER MAILADDRESS CITY 2" PHONE <br />CONTRACTOR <br />r— <br />MAIL ADDRESS City ZIP PHONE LICENSE• <br />l912 t' e. <br />MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />P;;LL�UMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORN <br />ElNEW ❑ ADDITION © ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />'ALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />Nf/ ^ Yi- r/ ;'pwAri <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIO,4 AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO14S OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE FCONTRACTORORAUTHORIZEDAGENT DATE <br />X 'A;�, �✓ T <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT- BLOCK_ OF <br />PROJECT ADDRESS <br />31 SE !&_i <br />A PLIC ITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />N_ol <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />_ <br />_ <br />KITCHEN SINK A DISP, <br />AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />_FORCED <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />I CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />- <br />FLOOR DRAIN <br />AIF HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS- RAINL EADE FS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />Q11 IQ�l <br />SUBTOTAL <br />SUBTOTAL $ <br />�•�i <br />_ <br />PERMIT f <br />_ <br />PERMIT <br />TOTAL FEE 3 <br />�C <br />TOTAL FEE S <br />JI� <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I RONT SEIBACI'. <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />I'LAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />ISE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />FYP-OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UFIITS <br />BUILDING <br />S <br />AZE OF BLDG <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />7 <br />--- <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />MECHANICAL <br />�1 <br />OTHER <br />PENALTY <br />TPPUCAiION ACC BY <br />PIANS CU[CKED OY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />