Laserfiche WebLink
I K_ <br />A. PLICATION FOR <br />1 CONSTRUCTION �T1.IT <br />�IT. Of DF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />r 259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING 9 :SIGN <br />CM'NI R MAIL ADDRESS CITY ZIP PHONE I <br />FIEz.rIN3mL9 TTEATSLwTaY 28 CQL_ByAVF~ Exe¢a-)-1 <br />ARCHITECT OR DESIGNER MML ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY AP PHONE LICENSE A <br />TURF , Q (iL<-�ys l,.L'T.EIoxGl4C:3 `JLMTTJ= 4E1n4 I-®Op�.2-2-mYTy$>-�yj?stl4 <br />MECHANICAL CONTRACTOR MML ADDRESS CITY 'R, PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />4 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />VALU 11ON OF WORKICOST OF MATE. TIMES PL US LASORI <br />'4dc�oo <br />DESCAIBE WORK !!'—�� <br /><I III I I L 1 c/ TLT T / L n (.-/1 \/�/ A G T' F 1 FZ �/ _ CZ I �� Pmo- pi 1 &`I <br />.BE DF 9w1 DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PL ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONE RACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN FINOWOR ATTACH FOURCOPIESI <br />LOT_BIOCK-OT <br />PROJECT ADDRESS <br />. RS1 r <br />ARP C11 SGl USINESSLJCFNSE NO <br />30 8 <br />PLUMBING _ _ <br />NO, TYPE OF FIXTURE --� FEE <br />MECHANICAL <br />NO. <br />_ TYPE OF EOUIPMENT <br />. <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND UNITS -HI" EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY WASH BASIN <br />BOILERS-H P EA <br />_ <br />SHOWER <br />GAS FIRED A C UNITS -TONNAGE EA. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B T U M EA <br />_ <br />DISHWASHER <br />_WALLHEATERS-BTU M <br />LAUNDRY TRAY <br />UNIT HEATERS-0 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />_ <br />WATER HEATER <br />_ <br />OLOTMB DRYERS <br />URINAL <br />"ENTILATION PAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CFM <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS--RAIEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE-BAR ETC) <br />WOODSTOVE✓FIREPLACE INSERT <br />_ <br />BUS TOTAL <br />SUBTOTAL B <br />PERMIT B <br />PERMIT B <br />_ <br />_ <br />TOTAL FEE S <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />1'RONT SETBACK <br />USE ZONE <br />TYPE OF COAST <br />SITE OF BI UG <br />REAR SETHIrK <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />PLAN <br />FEE <br />CAECA FEE <br />RECEIPT NO <br />I OT AREA <br />VACANT SITE <br />OYEB ONO <br />FEES <br />VALUATION <br />fEE <br />OCCUPANCY GR'IIP <br />NO OTDWELLINGUNIIS <br />BUILDING <br />S <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED D YES D NO <br />MECHANICAL <br />OTHER <br />L <br />PENALTY <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE By <br />r1 % <br />TOTAL <br />A't <br />S <br />