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I APPLICATION FOK <br />FINE E"' "" <br />clrr OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ G;:MBINATION ❑ BUILDING ❑ MECHANICAL <br />MAIL <br />MAIL <br />ZIP <br />rdl <br />❑ PLUMBING t9SIGN <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS COY <br />ZIP <br />PHONE LICENSE <br />Tr <br />�T Agrr <br />CIS c � AGcw,-1 sr- <br />Talc 9 <br />Z�? 1 OfIZ / <br />MECHANICAL <br />CONTRACTOR <br />—T MAIL ADDRESS Clry <br />ZIP <br />PHONE LICE'ISE• <br />77J• Cam. • A� �-311 QS <br />PLUMBING CONTRACTOR <br />.AIL ADDRESS CITY <br />ZIP <br />PHONE LICENSE <br />❑ NEW ❑ ADDITION Vll ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK IC09T OF MAT EIIIALS PLUS LABOR) <br />DESCRIBE WORK ^� <br />__A.. L1.F :. I,c//_.AI .A.Vn c 1210 DY•a1A;C I-i..=TN <br />u9e or ew�DiNa �— <br />I HEREBY CERTIFY THAT I HAVE READ ANU EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANC CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING TH13 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULAT'NG CONSTRUCTIGN <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTR TOR OR AUTHOFH7Eq.AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT— BLOCK OF <br />PROJJCCT ADDRESS <br />50CP ilrte= S• C . <br />LI, SCITY B,ow SSl SEND. <br />Z���� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE _- <br />WATERCLOSET(TOILER <br />_ <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 />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK 3 DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-S T.U. M <br />_- <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS-R.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS__ _ <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD _ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M <br />-- <br />- <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL _. 3 <br />_ <br />_ <br />PERMIT <br />TOTAL FEE 3 <br />TOTAL FEE __ 3 <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IRONT St TBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER <br />FEE <br />USE ZONE LOT AREA VACANT SITE <br />OYES CNO FEES <br />TYPE Or CONST OCCUPANCY GROUP NO. OF DWELLING UNITS <br />BUILDING S <br />SIZE OF BLDG NO OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />APPLICATION ACC BY PLANSCHECKEDBY APPR FOR ISSUANCE BY <br />TOTAL <br />!43/aeu.,L.r.ulq � <br />eXs T�cava�� Pt�oP A i it -I a <br />PLAN CHECK FEE <br />I RECEIPT NO <br />VALUATION I FEE <br />lSfls jt:hGE5u,-r TU <br />L ) bli�;e 4:- <br />`�5F'=7 b-isnoe Creot� <br />