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s�r <br />F <br />ArPLiCATION FOI <br />CONSTRUCTION I. <br />everett <br />PERMIT <br />BUILDING DEPAHTMENT <br />269•8810 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />F(DEMOLITION ❑ COMBINATION „_,-q_B14LDING ❑ MECHANICAL <br />y ARCHITECT OR U FSIONER MAIL ADDRESS UIIT A"' <br />GENERAL CONTRACTOR MAIL ARORf SS CITY III, <br />�dYAP <br />❑ PLJMBING ❑ SIGN <br />PHONE <br />PHONE <br />PHONE <br />MECHANICAL LANTPACTOR MAIL AUUFH:5b • "' ' •""" """• `� <br />PLUMBING CONTRACTOR MAIL ADDRESS Clry lU• PHONE LICENSE A <br />CLASS OF WORM ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR a DEMOLITION ClWJODSTOVE/T'RPL. INSERT 0 BUILDNG RELOCATION <br />VALUATION OF WORK IC051 OE MAtE 1.3 PLUS LABOR) <br />DESCRIBE WORK / <br />VL- '#`AO n" . A, I 'n /A� A/ n G <br />F <br />USE Or BUILDING <br />I HEREBY CERTIF Y THAT I HAVE READ AND EXAM114ED THIS AP- <br />6 F12 <br />PLICAT ION AND KNOW THE SAME TO BE TRUE A14D CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEOAL DESCRIPTION OF PROPEPTY ISHOWN BELOW OR ATTACH YOU" COMFSI <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BLOCK __OF <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 PERFORMA14CE OF CONSTRUCTION. �.� � �e <br />bA SIGNATURE OF CONTRACTOR OR AUTHORWED AGENT OAT FZ p <br />PROJECT ADDRESS <br />APPL..ANrB CH SINF SS IICENSIF NO <br />PLUMe1NG <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE ON ITEM <br />FEE <br />NO. <br />I TYIFE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS - IF P <br />BATHTUB <br />REFRIGERATION UNITS - HP EA <br />LAVATORY IWASH BASINI <br />BOILERS - B T U /H P <br />SHOWER <br />GAS FIRED A C. UNITS - B T U <br />KITCHEN SINK B DISR <br />FORCED AIR SYSTEMS - B T U M FA. <br />DISHWASHER <br />WALL HEATERS - B T U M <br />LAUNDRY TRAY <br />UNIT HEATERS - B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVF.NTERS <br />WATER HEATER _ <br />ROOF DRAINS - RAI.NLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR, ETC) <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EAHAUSTFAN <br />BUD TOTAL <br />f <br />BUD TOTAL <br />PERMIT <br />t <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />1 <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />iPpn• SE TBACA <br />USE LONE <br />LOT AREA <br />VACANT SRF <br />FEES <br />VALUATION <br />FEE <br />S <br />OYES nNO <br />_ <br />BUILDING <br />TYPE Or CONST <br />OCCUPANCY GROUP <br />NO OF DWFLIING UNITS <br />PLUMBING <br />BITE OF BLDG <br />NO OF STORIES <br />MAX OLC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />STATE ENERGY SURCHARGE <br />ANPUCAnONACC BY <br />PLANS CrIELKFO RY <br />APP. Fpn ISSUANCE B, <br />PUBLIC WORKS <br />TOTAL <br />�SJ� <br />n eI I <br />YHVYCNIT L,vno..o...a... .......-__. .. __._..... _ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />