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the Ewrgwn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8745 <br />❑ DEMOLITION <br />hYPLICATION FOi <br />CONSTRUCTION <br />PERMOT . <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ COMBINATION C"UILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />�n n mniL nVVncos CITY ZIP PHONE <br />-ev� evevTsev� Z?O I t , aOL � (�c�erei �iR2Dlo <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />�.L✓11Q <br />GENERAL CONTRACTOR <br />cu3n <br />MAIL ADDRESS <br />-po &x <br />Be[(-Puv('- <br />CITY ZIP <br />PHONE LICENSE <br />Q400q <br />9,53.33H? r_wgco=21 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE <br />PLUMBI'ICACONTRACTOA MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />V ;EI NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUAIION OF WORK (COST OF MATERIALS PLUS LABOR) <br />:�7 1O1500. I <br />D <br />f <br />l <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUE AND CORRECT. 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 PERMITDOES NOT PRESUME TO <br />GIVE AUTHOI'ITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER Sl NTE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFOCMANCE OF CONSTRUCTION. <br />SIGNATH� FCON''TR,,CTOR OR AUTHORIZED AG EN DATE <br />PROJECTADDRESS -e5 C� <br />q ue r if (,f Q n tn)Kud�f_aJ <br />APPLICANT'S CITY BUSINESS LICENSE NO. �- <br />PLUMBING NJ <br />MECHANICAL. <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <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 />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SY,%EMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS--L.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.I.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING_U IT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 5 <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S <br />FRONT SETPACI <br />USE ZONE <br />TYPE OF CONST <br />SIZEOF LDO <br />1f.1. <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK I SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />A <br />VACAN SITE <br />OYES O <br />8-I 1 0 <br />OF STORIES MAK OCC. LOAD <br />FIRE SPRINKLERS REQUIRED ❑ YES Df NO <br />ACC. BY I PLANS CHECKED BY I APPR. FOR <br />Jer-. I �,. <br />FEE � RECEIPT <br />o Vl rFEESJ VALUATION FEGEJ J' 7 I] <br />BUILDING & <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />