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`" P�L�I�CATION FOR'`'�'� <br />ITYOF .R COiNSTRUCTI©N <br />everett 'PERMIT le - <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Fir7& n ram{ fi?�nk 75LQ2 E( JnrF g ak, ��.+(Iefi- 2 Cl-- 35C <br />ARCHITECT OR DESIGNER MAIL ADDRESS Cltt J ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />), NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INISERT ❑ BUILDING RELOCATION <br />VZ;;CATION OF WORKIC09T CF MATERIALS PLUS LABOR' <br />3' <br />uBE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISI DNS OF LAWS AN D ORD I NA NCES GOVE R N I NG TH IS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OF PERM IT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY Ol-HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />- <br />SIG TURE OF ONTRACTQ$I:e11UTHORIZED AGENT DATECc <br />rp <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT —BLOCK —OF <br />Ll <br />PROJECTADDRESS <br />APPLICANTSCI YB1(SINE SS LICEN NO. <br />PLUMBING <br />ME ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />_ <br />FEE <br />WATER CLOSET TOILET) <br />AIR COND. UNITi—H.P. EA. <br />BATHTUD <br />REFRIGERATION UNITS—H.P. EA, <br />LAVA. ORY(WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UN11S—TONNAGE E/L <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEM:•—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY'FTAY <br />UNIT HEATERS—R.T.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 UNIT— C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAM'S—RAINLEADERS <br />_ <br />METAL FIREPLACE d CHIMNEY <br />SINK SERVICE --BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE $ <br />THIS PORTION TO <br />BE COMPLETED <br />BY BUILDING <br />DEPT. PERSONNE L <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE <br />RECEIPT NO. <br />USEC I <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCYOROUP <br />I NO. OF DWELLING UNITS <br />I <br />BUILDING <br />BLDG. <br />NO, OF STORIES <br />'MAR. OCC. LOAD <br />PLUMBING <br />PRINKLERS REQUIRED ❑ YES 7 NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />TACC. BY I <br />`.ION <br />PLAZC SV <br />I APPR. FOR i95UANCE BY <br />— <br />TOTAL <br />E <br />