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''APPLICATION FOkz evereR <br />The <br />'°'Ne <br />Cl"f)FCONSTRUCTION <br />ln n <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ® BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESScm ZIP PHONE <br />M D [)Tic Qn1E_ Ke.le el.. RI•LI EVEQFtf q?J 20.3 735-3-278o <br />GENERAL CONTRACTOR MAIL ADDRESS Cln ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR -- MAIL AUDRESS CITY ZIP PHONE LICENSE- <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />El NEW ❑ ADDITION ❑ ALTERATION ❑ RE -AIR 9 DEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERM'.S PLUS LAOORI <br />' -- . F .,. M31r.,•...�#3 <br />- <br />DESCRIBE WORK r N. 4A I110I/OGI'n0 13r mo tO 1 1.1 /A IirLt II10 "Eli) �. C. LD <br />(A.I - ---- <br />USEOFBUILDING <br />Sliows hewir #3 <br />- - - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. TPE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />IN <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOIHER STATE ORLOCAL LAW REGULATING CONSTRUCTION <br />OF, THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x I . lc_. !lcv..2 /96Q. <br />APPLICANT'BCITYBUSINESS ICENSENn <br />.AkMDRvinG <br />F PROPERTYI5NOWN BELOWORATTACH FOURCOPIE51 <br />BLocK�._oF Pvsn A <br />_Cgpjy_._&S' I N EAcCCR 1 E1 ikuze,D <br />CCLL .iL <br />L1 <br />R refuto IPA JoLvme Al aG 2-4 <br />ritc,ofLDA ul C,n0\,1UYy1'S`. COontu•I <br />n <br />PROJECT ADDRESS VDIb Qj[V�DLLC� /RLy RL.FI�I <br />CvcaetiW , I,, "llbZ03 <br />PLUMBING Aj a I c <br />MECHANICAL N NL: <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.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY(WASH BASIN( <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />I <br />LAUNDRY TRAY <br />UNIT HEATERS—B.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 />STOVE _ <br />— <br />ROOF DRAINS—RAINLEADERS <br />I <br />_ <br />METAL FIREPLACE A CHIMNEY __ <br />—_ <br />SINK SERVICE —BAR. ETC. <br />WOODSTO':EIFIREPLACE INSERT <br />SUBTOTAL <br />I <br />SUBTOTAL S <br />PERMIT A <br />PERMIT B <br />_ <br />'OTAL FEE A <br />TOTALFEE IT <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACF <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS'. <br />OCCUPANCY GROUP <br />_ <br />NO. OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE Of BLDG <br />NU OF STORIES <br />MAX OCC. ICAO <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED DYES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATIONACC BY <br />PLANSCUECKEDDY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />