Laserfiche WebLink
tPPEICATION Folh,' <br />cmOor rho ""° CONSTRUCTION <br />r <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION CI COMBINATION O BUILDING ❑ MECHANICAL PLUMBING <br />❑ SIGN <br />A nC✓i i I,CI Ej <br />nt,10"ER <br />MAIL ADDIIL59 <br />611Y ;1:1 <br />PHONE <br />—� <br />4EIIE/C'`` <br />MAII ADDRESS <br />' <br />1MACIOR <br />Al fi ...Ii- (teDw �- T^/•-n <br />/�•.., l /n 1— <br />�7 CITY /IP <br />r7�Vn 1<w ..,./2 G,rt.� ^f F'IT> .) <br />PHONE <br />LICNISL <br />IAETIIANICA. L'nNTNACTOR <br />' MAIL ADDRESS <br />city <br />ZIP PHONE <br />LICt NST <br />I <br />` <br />PLUIIRnn,CONI Aclon V' <br />MAIL ADDRESS <br />Cov <br />ZIP wwNF <br />LICENSE . <br />k ..1... <br />T720- IS3 O.Q. II ['. <br />CT,.O, .•L P'_... lTf.. <br />iLIT T.3 3 nt <br />is Y' LL l41(ep <br />CLAA511 Wolf- <br />0 NEW k] ADDITION ❑ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPLANSERT ❑ <br />BUILDING RELOCA11014 <br />VI WPOI. or won ✓, Cost OF LFA I L IIIA LS IxuSI ABORT <br />A 9` <br />— <br />DF SCDi04. VIORK 4 <br />USE Or I'.UILDING <br />1 `1�wa. - i)a <br />. <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 />PROVISIONS OF LAWS AND ORDINANCES GOVE FINING THIS T YPE <br />OF WORK WILL BE COMPLETED WITH WHETHER 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 />SIGNATURES OOF CONTRACTOR OR AUTHORIZED AGENT DATE <br />as DAL RI Sk nIPTION Fit PnOPun Y1RITOWN BELOW Oil AINCIf I OUDCUPILS1 <br />Lot_-SLOCK­ OF <br />- <br />PROJECT ADDRESS <br />APPLICANTS C11Y BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—A/HNDLG UNITS —H P. <br />BATHTUB <br />REFRIGERAtICN UNITS —14P EA. <br />LAVATORY I WASH BASINI <br />BOILERS — B.T. U.IH P. <br />SHOWER <br />GAS FIRED A C. UNITS — B.T.U. <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS — B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS —8.T U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOT 14ES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOD DRAIN <br />RANGE HOOD <br />13M1CKFLOW PREVENT EnS <br />WATER HEATER <br />n OOF DRAINS — nAINLEAOERS <br />WOOD STOVE <br />SINK ISEnVICE — BAR. ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAP PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />`r <br />PERMIT <br />TOTALFEE <br />f <br />�=' <br />TOTALFEE <br />_ <br />INONr SFTOaC.e <br />MAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />11FARSETBACK <br />SIDE SETBACK <br />USE ZUNt <br />I Of AREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />hPF Or C.ORST <br />OCCUPANCYGPOUO <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE Or RIDU <br />NO or sionlES <br />MAX OCC LOAD <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑ YES O NO <br />OTHER <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPI ICAtION ACC By <br />T•I FlTS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC\YORhS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINI NO ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />r <br />