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,IPPLICATION F0 <br />TheCm of IT EY.r°'"° CONSTRUCTION 0 <br />c <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION P'DUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />Oman MAIL ADDRESS CITY Zrr NDN[ <br />GA—/"lIEy 1 151? lleI,01 <br />AIICrurECT On DESIGrLn MAIL ADDRESS CITY ZIr PooNr <br />LICENSE . <br />1u7�f" <br />VLt��I- <br />L.J�jY111�T� <br />(;< (41 <br />G � j' ��a�Llr'IUJ>11/j�iL�is��T <br />Uq-1�JC.IP-7 <br />MEulAN1Al <br />CONTRACTOR <br />MAIL ADDRESS <br />CNY <br />DP PRON <br />LICENSE. <br />PLUMBRIOCONTRACtOn <br />MAIL ADDRESS <br />CITY <br />ZIP FRONT <br />LICENSE. <br />CLASS Or WORK <br />❑ NEW ❑ ADDITION <br />�4 ALTERATION ❑ <br />REPAIR ❑ <br />DEMOLITIOrJ ❑ <br />WOODSIOVE/FRPLANSERT ❑ <br />BUILDING RELOCATION <br />VAT OANnN or wonK IM91 Or MAIL <br />RIOLS PLUS LABOR <br />DESCRIBE WTIRK <br />Izhlir-_IGML Sctu.� rI wI15I-I - �mLlsT mF II-iT Efz10R- d=Flr_F FA�tio1.IS <br />USE or nTr1T7- T T � <br />�C-IA�L <br />T- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK'WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />INOR NOT. THEGRANTINGOFA 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 TJE PERFORM CE OF STRUCTION. <br />$IG 1 E CONTRA J 9 10 17E ENT OAT[ <br />X � L <br />AFI'll'ANTB CITY RU$INEB$IICF F. Nn r <br />LEGAL DE L or POPEmrL,NOWNNELOWOn AIIACHroun COPIES <br />LOt_BLOCK Or_ <br />_ <br />PROJ[CI ADUREss ' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET(TOII.ER <br />AIR COND UNIIS-H. P. EA. <br />REFRIGERATION UNITS-H.P. EA. <br />_BATIITUB <br />LAVATORY ( WASH BASINI <br />BOILER'r H. P. EA. <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />_ <br />_ <br />_SHOWER <br />SINK 6 DISP. <br />FORCED AIR CYSTEMS-B.T.U. M EA. <br />-- <br />-KITCHEN <br />O'SI iiVNSHER <br />— <br />— <br />WALL HEATERS-B.T.U. <br />LAUNDRYTRAY <br />_M <br />UNIT HEATERS-B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />IYATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />V2NIILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />DRAIN <br />HANDLING UNIT- C.F.M. <br />_ <br />_ <br />_FLOOR <br />VACUUM BREAKERS <br />_AIR <br />_ <br />ROOF DRAINS-RAINLEAUERS <br />_STOVE <br />METAL FIREPLACE A CHIMNEY <br />_ <br />SINK (SERVICE -BAR. ETC) <br />WOODSTOVE/FIREPLACE INSERI <br />SUBTOTAL <br />SUB TOTAL s <br />_ <br />PERMIT s <br />PERMIT f <br />_ <br />TOTAL FEE 6 <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I PONT SETBACK DEAD sEIBACK SIDE SETBACK PLANCIIFCK NtJrD€R, PLAN CNECK FEE <br />AI'1 Iv/1 tin E[ RECEIPT NOC <br />USE ZONE LOT AREA A/ aygCANT SIZE / <br />FEES VALUATION I FEE <br />JI,I <br />OYES Z%+O <br />TYPE OF coN'1 <br />OCCUI`ANCr GROUP <br />�2 <br />OF ON'f LU <br />s12f 0r 01nI,nR� <br />NO or STORIES <br />MA[ OCC L(O'A <br />FIRE SPRINKLERS REQUIRED ❑ 1E5 WI NO <br />APPI (CATION ACC By <br />1`LAHS CRECKE0 BY <br />APPR FORIssI <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />