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,. EH,ORIIR '-APPLICATION FGA <br />ITYOF CONSTRUCTION <br />Everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />UILDING DEPT. <br />59-8745 ❑ COMBINATION ❑ BUILDING !J j MECHANICAL ❑ PLUMBING ❑ SIGN <br />1/'1✓///Z. !///- IL'/V//K716i <br />717;1T?7 <br />f--ncZ7///n1Uq <br />`VI r-_r:v <br />-v —U <br />.1 1. iU <br />'C141TECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />NERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />fW;ICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />Ai�z <br />UMBING CONTRACTOR <br />MAIL ADDn"S <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />ASS OF WORK.,( <br />NEW Id- ADDITION <br />❑ ALTERATION <br />❑ REPAIR <br />❑ DEMOLITION <br />❑ <br />WOODSTOVE/FRPLARSERT <br />❑ <br />BUILDING RELOCATION <br />LUAIION OF WORK (COST Or MTd ERIALS PLUS LABOR) <br />SCRIBE WORK 7 <br />i/) C' i Y�/ T I-) Tim" n i% /,", 1j 11Ai 1)A)//. 41P <br />E or BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSA14D ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH W14ETIIER 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x 22 <br />GAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />T_BLOCK_ —OF <br />OJECT ADDRESS • -k`v <br />'In) Cc/c, w /11b. <br />APPL Y,ANTS CITY BUSINESS LICtNSt NO. <br />//2IV7 <br />-UMBING <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.R EA, <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />LAVATORY (WASH BASIN) <br />BORERS-H. P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK A DISP, <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEAIERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <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 />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 6 CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />_ <br />PERMIT f <br />_ <br />TOTAL FEE S <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING <br />DEPT. <br />PERSONNEL <br />)NT SETBACK <br />I REAR SETBACK <br />I SIDE SETBACK <br />I PLAN CHECK NUMBER <br />I <br />PLAN CHECK FEE <br />E ZONE I LOT AREA I VACANT SITE <br />OYES ONO <br />FEE I RECEIPT NO. <br />I FEES I VALUATION I FEE I <br />BUILDING <br />E OF BLDG. NO. OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />iE SPRINKLERS REQUIRED O YES O NO <br />OTHER <br />PENALTY <br />'LICATION ACC. BY PLANSCHECKED BY APPR, FOR ISSUANCE BY <br />TOTAL <br />f <br />