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4"PI [CATION F00 <br />IT OF CONSTRUCTION <br />i everett PERM1: <br />BUILDING DEPARTMENT <br />269.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />)(DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER .MAIL ADORE 95 CI JIP PHONE <br />ARCHITELTORDESIONFR MAIL ADDRESS CITY JIP PHIINE <br />�C� <br />j GENERAL CONTRACTOR Mlel PDRESS CITY !IP PHONE LICE NS[ <br />MECHANI L '-ACTOR MAIL ADDRESS CITY 21P PHONE LICENSE <br />1 <br />I PLUMBING CONTRACTOR MAIL ADDRESS OTV ZIP PHONE LICENSE. <br />I CLA550F WDAK <br />I ❑ NEW ❑ ADDITION Cl ALTERATION ❑ REP41P 4 DEMOLITION ❑ W-JOOSTOV:/FRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WOIIII (COST OF MAIERIALS PLUS UBORI <br />1 <br />1 DESCRIBE WORK <br />1 '7'—,Y /,N %% AJI /1 / V <br />UBE O IBUILOMU ! ,� <br />j�G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TORE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 ME PERFORMANCE OF CONSTRUCTION. /�/��%33'' <br />SSIIGJA TURE OF CON TRAC IOR OR A�UT,HORIZED AGE FIT GATE J O' C <br />Z <br />LEGAL DESCRIPTION GF PROPERTYISHOWN BELOWORATTACHrtm-xPIrS• <br />LOT_BLOCK_OF <br />A-,�- <br />fj <br />PROJECTA0011E35 <br />.40 . Wes <br />AP.LICAN FS CITY NOSINESS LICE TOTE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />Np, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - AIHNOLO UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - HP EA. <br />LAVATORY I WASH BASIN) <br />BOILERS - B T U IH P <br />SHOWER <br />GAS FIRED A C UNITS - BTU <br />KITCHEN SIIIA B DISP <br />_ <br />FOPL'ED ALAI SYSTEMS - B T U M EA <br />DISHWASHER <br />WAL L HEATI_RS - R T U IA <br />UUNDRYTRAY <br />UNIT HEATERS -0T.0 M <br />CLOTHES WASHER <br />EVRPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE -BAR. ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING _ <br />EXHAUSTFAN <br />BUD TOTAL f <br />BUR TOTAL <br />PERMIT f <br />IKRMIT <br />TOTAL FEE 11 <br />TOTAL RE <br />FRONT BE TRACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE OF LONSI <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />PLUMBING <br />BIZf OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTFIEP <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SLRCHARGE <br />APPLICMIONNAAC'C BY <br />"""FFF///�VVV <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC IVORXS <br />TOTAL =----- <br />E <br />pBI�BOP.1�T'EIAM4alIPAT;'•'" I, � I - <br />YNVi-LIII I vl.l�a....a n..�....v. v..... _ _ <br />PROPERTY LINE I OCATIONS AND RELATED EASEMENTS. <br />