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'-.:PPLICATION FO.�) [61 <br />theCIT EYerOrsan <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION p-BU LI DING ❑ MECHANICAL ❑ PLUMBING L}9tGN <br />OWN R MAIL ADDRESS CITY ZIP PHONE <br />Ca-,'e zg3i �Pa����/ 6; Ivere/7g�zo� �v�r-zz� <br />ARCHITECT OR DES) IER MAIL ADDRESS - 'Y ZIP PHONE <br />CH ZIP PHONE LICENSE - <br />DRES <br />GENERAL <br />MECHANICAL�CONT➢ACTOR MAIL AD DDE55 CITY UP PHONE LICENSE <br />.G.lM7X/ . , /i//U �i4r //.�%> �Lr <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PI(ONE LICENSE <br />CLAMS WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSE RT El BUILDING RELOCATION <br />VAVON OF WORK (COST or MATERIALS PLUS LABOR) <br />DESCRI E VORK I <br />J �7/eerds c%�F <br />USED BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) pROVI SIGNS OF LAWSAND ORDINANCES GOIcRNING THIST'/PE <br />OF WORK WILL BE COMPLETED WITH WHETHEI I SPECIFIED HERE- <br />LOT- BLOCK— OF 1 IN OR NOT. THE GRANTING OF A PERMIT DOE;, NOT PRESUME TO <br />GIVE AUTHORIT-! TO VIOLATI. OR CANCEL Th ' PROVISIONS OF <br />ANY OTHER STATE OR LOCAI. LAW REGULATIN.i CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />EIGNATURE OF CONTRACTOR OR AOTHORRED AGENT DATE <br />X Gz1 � z1 ? i2�/�� <br />PROJECT ADDRESS APPLICANTS BUSINESS LICENSE NO. <br />PLUMBING _ MECHANICAL <br />NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) AIR COND. UNITS—H. P. EA. <br />BATHTUB REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) BOILERS—H.P. EA. <br />SHOWER GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. _ FORCED AIR SYSTEMS—B.T.U. M EX <br />DISHWASHER WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY _ UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER EVAPORATIVE COOLERS <br />WATER HEATER CLOTHES DRYERS <br />URINAL __ !METAL <br />ION FAN <br />DRINKING FOUNTAIN OOD _ <br />FLOOR. DRAIN __ LING UNIT— C.F.M. <br />VACUUM BREAKERS <br />ROOF DRAINS—RAINLEADERS REPLACE A CHIMNEYSINK(SERVICE—BAR. ETC. OVE/FIREPLACE INSERT <br />_ BUD TOTAL SUBTOTAL S <br />PERMIT S PERMIT E <br />_ TOTAL FEE S TOTALFEE S <br />THIS PORTION TO BE I,:OMPLETED BY BU LDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SE TRACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE LOTAREA VACANT SITE FEES VALUATION FEE <br />DYES ONO -- <br />TYPE Of CONST. OCCUPANCY GROUP NO. OF DWELLINO UNITS <br />BUILDING 5 <br />SIZE Of BLDG. NO OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />OTHER <br />PENALTY <br />APPLICATION ACC BY PLANS CHECKED BY APPR. FOR ISSU`v Y <br />TOTAL <br />I r <br />2111111111111111 <br />:T -V <br />