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'71 <br />APPLICATION FOR <br />rho Ew.prnn <br />CIn OF <br />CONSTRUCTION <br />rArrrN <br />everett <br />PERMIT <br />e <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ <br />SIGN <br />OWNER ^ <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />7 <br />!?lVlF��J!%% <br />//fkf <br />3�5=-� a�! <br />ARCHII OTORDESIGNER W <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />Y <br />GENE..AL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />❑ NEW El ADDITION (2 ALTERATION ® REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILD114G RELOCATION <br />�E µDpTlrjNOF WORKICOST OF MATERIALS PLUS LABOR) .f��/U(J K PcAr. T%o60'r <br />a Ns• / / S- New a l �� vs uF r /A /i /rf )-eA'Lr l iUt 41C <br />DESCRIBE qF+K <br />i �I i <br />USE OF JJCDING <br />I HEREBY CERTIFY THAT I HAVE READ AND E.YAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO SE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />'�X, �Y <br />A LI ANTS CITY BUSINESErLICIFNSE NO. <br />LEGAL DESCRIPTION OF PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_SLOCK—Or <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H P. EA I/ <br />lA <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS-H. P. EA. <br />SHOWER <br />I <br />GAS FIRED A C. UNITS -TONNAGE EA <br />KITCHEN SI NIX DISP, <br />FORCED AIR SYSTEMS-BT.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <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 />ROOF DRAINS-RAINLEADERS <br />I METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />00 <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />eJ <br />SUB TOTAL f <br />a <br />PERMIT f <br />PERMIT f <br />TOTALFEE { <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />NI A <br />gDE SETBACK <br />PLAN CHECK NUMBER <br />� �/ / A_ /� r � <br />T �i L7 <br />PUN <br />y ,3 <br />FE� 3 <br />GHEOK FEE <br />RECEIPT NO. <br />// <br />U$E ZON�- <br />LOT AR <br />VACANT ES SITE <br />JO <br />/C <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />'17 _ 'q <br />-SLOG <br />OCCUPANCY GROUP <br />IS - Z_ <br />NO. OF DWELLING UNITS <br />D <br />BUILDING <br />82I � <br />SIZE OF/ <br />y/o L/ sr <br />NO OF STORIES <br />/ <br />MAX. OCC. LOAD <br />J <br />PLUMBING <br />-- <br />O <br />FIRE SPRINKLERS REQUIRED OYES WrNO <br />MECHANICAL <br />`v <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />pPPR FOR ISSUANCE BY <br />TOTAL <br />2110 <br />�3aa <br />_ <br />/Q <br />