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r <br />L <br />APPLICATION Flit "PIBN <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. p <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ® SIGN <br />OWNER MAIL ADDRESS gltY :I' PHONE Y <br />1 sT tti i s174Iii2L5-_Ie a IRL COT_-oyAva- F-vEE,eT-7- B <br />ARCHITECT OR 7ESIGNER MAIL AODRl SS J CITY ZIP PHONL <br />1 <br />1 11 HERAT. CONTRACTOR MAIL ADDRESS <br />il[�ATzrO15c�LF� P�,BoxC <br />MECHANICAL CONIRACIOq MAIL ADDRESS <br />'LUMPING CONTRACTOR MAIL <br />.r nnI <br />-soD-xz-2asy 3i�6�ii <br />I'ITONE LICENSE A <br />INIONL IICFNSLA <br />CLASS OF WORK <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />MILA 11Oq OF WOPK (COST OF MATERIALS PLUS LABOR( <br />a O -- 0 <br />DESCRIBE WORK <br />I EJC Vl 1 SIC IJn"k lnl GI 1C N Illn.o'T " l^I C21 r`/ 4?s, <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS7YPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />G!VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER S7ATE OR LOCAL LAW PFGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURL. OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />t EGAL DESCRIPVON OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />Lot_BLocr_oF <br />PROJECT ADDRESS <br />a Sll LpL,By Ail Ez <br />An IL NtSCI GUSINt SSLICFNSE No <br />30 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TVPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EGUIPMENT FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS-H.P. EX <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY IWASH BASINI <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A . UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK B DISP <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CF M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAIN S-RAINLEADE PS <br />METAL FIREPLACL A CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODStOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />_ <br />TOTAL FEE f <br />_ <br />TOTAL FEE f <br />177 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I ROW SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PI AN CHI CK FEE <br />FEE IRECEIPT NO <br />USE <br />TYPE OF CONST <br />VACANT SITE <br />❑YES ('NO <br />OCCUPANCY CROUP <br />NO OF DWELLING TIMIS <br />BUILDING <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />'.PIS REOUIRED �'3 YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE GY <br />TOTAL <br />S <br />VALUATION I FEE <br />■s_ <br />