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rAPPL.ICATION F4.. �,�3,6 <br />CITE"'°"'" clrr of + CONSTRUCTION G f F, rlP <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMFLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION .BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEN MAIL ADDRESS CITY , ZIP PHONE <br />MAIL <br />I IGE'!SC � <br />�A�nli <br />MECHANICA L. CONTRACT A MAIL ADDRESS CITY ZIP PHONE UC[NSI . <br />PLUMBING CONTRACTOR MAR AGGRESS CITY ZIP PHONE 14 L NSE' <br />CLASS OF WORK IIC�II <br />ElIJEW ❑ ADDITION 0L ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />wI I IATI IN nF WORI, IC057 OF MATLRIALS PLUS LABORI <br />I A IT- i. r�N 1t M F Lf'iC <br />N <br />USE T nuI,DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TOBE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH VIHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERM I. 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 />S'GNATU E OF PONTAACT RO AU ZE AGENT DATL <br />X U. I-?-3 g7 <br />LEGAL DE cRIPnDN OF PROPERrr lsHow B LOW OR ATTAbA oun copal( <br />1-�7 �7E�, <br />LOT�BLOCK�OP F <br />r <br />PROJECT A -DRESS <br />PLUMBING <br />APPLICAN SCIIY RU$INES LICLN.E1:0 <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />AIC — AIHNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY ( WASH BASIN) <br />BOILERS — B T.0 IH P <br />SHOWER <br />GAS FIRED A C. UNITS <br />KITCHEN SINK A DISP <br />FORCED AIR SYSTEMS — B T.U. M EA. <br />DISHWASHER <br />/ <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T U M <br />CLOTHES AS <br />EVAPORATIVE COOLERS <br />CLOT' IFS DRYE—J <br />FOUNTAIN <br />..N 'I T <br />FLOOR DRAIN <br />RA OD <br />UACKFLOIV PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE —CAR. ETC 1 <br />METAL FIREPLACE A CHIMNEY <br />' <br />FIREPLACE INSERT <br />_ <br />MEAT PUMP <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />SUBTOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />IF <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />Imo— I <br />LOT AREA <br />VACANT SITE <br />2YLS.XNo <br />I FEES <br />VALUATION <br />FEE <br />BUILDING <br />y <br />T •� Fj�, <br />l `]' <br />TYPE OIfn4CT <br />N <br />OCCUPANp`Y GROUP <br />/J 'Z <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF SLOG `, f <br />47- .J r <br />NO OF STORIES <br />MAY OCC LOAD <br />G <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES p;NO <br />STATE BUILDING SURCHARGE <br />..- <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />XIAA ' <br />PLANSCHECKEDBY <br />_ <br />�►L`{� <br />_ 4 <br />- <br />APPA FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />I.,Y.TA I. v.. I. I n d n n.. ..-... .a.....-__ _..__. _....... ..__..__ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />