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the EorOrNR <br />GTY DF <br />everett <br />BUILDING DEPARTMENT <br />259-8745 <br />APPLICATION FO.. <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />evereR <br />9 DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�.y�� a[evr r MAIL ADDRESS Cltt ZIP PHONE <br />.10 <br />/y.MAIL ADORE55/�y��N��J�S CITY I. .ZIP 3 PIfOH[ <br />AR�NH ECID! DES)I' UrFCK 18/2 14-w " r _^• w,&• l � y <br />N <br />ERAL COLO B TOn MAIL apDREss Gtt 21P PHONE uCENSE <br />FLA�c�r' r.�<_ ,' �cvTzP R�• BoK (dol �N!j cc�rN. 4�alo 77y z7iz <br />GE <br />MECHAN UL CONTRACTOR 1/AIL ADDRESS EI1Y ZIP <br />PHONE LTC. NSE <br />CITY $IF PHONE LICENSE <br />PLUMSIN CONTRACTOR M!'�ADDRESs • <br />CLASS OF WORK <br />❑ NEW ADDITION ❑ ALTER/ -AIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION Or WORKC�O.LS�T Or ly_aTEnuLS PLUS LABOR) — <br />W —dV <br />DEscRIBE WORK / 4P`Ff1Y%0lT` JE/7K/' /LW 4.1►Ll�TD NP /'RIS` WAGS . <br />$ <br />USE OF BUILDING I HEHEBY CERTIFI" i iTAF I HAVE READ AND EXAMINED THIS AP- <br />�'E gSUI 0106, PLIGATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />OESCRIrnou of raorERlY lsrowN BELow oR niTACIT FOUR COPIES) PROVISION: OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL <br />DIE R,v llc: NOT OF WORK WI:LBECOMPLETtOWITHWHETHEilSPECIFIEDHERE- <br />LOILB'.oclt7-.or IN OR NOT, T HE GR.V4TI NG OF A PERMIT DOES PRESUME TO <br />GIVE AUTHORITY TO VICTLATE O'r. CANCEL THE PROVISIONS OF <br />ANYOTHFRS <br />AT RLUGAL LAW HC1 UL/AI Irv" L.L,Iv0I nuu 11 vn <br />"On <br />CONSTRUCTION. <br />CONSTRUCTION. <br />Tun/ OF C OR Au HOnIZEO AGENT DATE <br />`-� <br />29t1d s�T. EVrT <br />- <br />ANT' CITYSLICENSEND <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />-� <br />FEE <br />NO. <br />D. TS-NP EA. <br />WATER CLOSET (TOILET) <br />BATHTUB _ <br />_ <br />__ <br />REFRIGERATION UNITS-H. P. F.A. <br />PEFRIG RA71 <br />BOILERS-H. P. EA. <br />�- <br />LAVATORY (WASH BASIN) <br />__ <br />GFIRED AC. UNITS -TONNAGE EA <br />AS <br />SHOWER <br />FORCED AIR SYST Eids-B.T.U. MCA <br />KITCHEN SINKB DISP. <br />WALL HEATERS-B.T.U. M <br />_ - <br />DISHWASHER <br />_ <br />UNIT HEATERS-B.Tin <br />_ <br />LAUNDRY TRAY <br />EVAPORATIVE COOWATER <br />CLOTHES WASHER <br />_ <br />CLOTHES DRYERSVENTILATION <br />HEATER <br />FANURINALDRINKING <br />RANGE HOODAIR <br />FOUNTAIN <br />1/ANDLING UNFLOOR <br />DRAINVACUUM <br />- <br />SPEAKERS <br />STOVE <br />METAL FIREPLACESINK <br />ROOF DRAIN S-RAINLEADERS <br />SERVICE -BAP ETC) <br />__WOODSTOVE/FIRE <br />— <br />SUB TOTAL <br />-- <br />SUBTOTAL <br />PERMIT f <br />PERMIT f <br />TOTALFEE f <br />- <br />TOTALFEE f <br />THIS <br />PORTION TO BE <br />COMPLETED <br />BY BUILDING DEPT. <br />PERSONNEL. <br />FRONT SETBACv. <br />R=AR SETBACK <br />SIDE SETBACK <br />CLAN CHECK NUMBER <br />J <br />PLAN C"F CK FEE <br />Z� RECEIPT NO <br />�� �� N <br />FEE / <br />USE ZONE <br />LOIMCA <br />VACANT SITE <br />FEES <br />VAI UATION <br />FEE <br />M"/ <br />A/ <br />DYES KNO <br />TYPE OF CONST, <br />OCCUPAQ14GY GROUP <br />NO. OF DWELLING UNITS <br />CPO <br />/ <br />BUILDING <br />f�Q%• '� <br />l <br />SIZEOFM V/ACf <br />No or STORIES <br />MAX.000 LOAD <br />PLUMBING <br />Soo sF <br />MECHANICAL <br />ACC PY <br />/�- , /-/1 <br />PLAN5 CHECKEgDB•` <br />Jk IDB <br />OTHER <br />PENALTY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />