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MEEYPro,..n �—,PPLICATION FOB.) EYP,P„ <br />r,ITY OF CONSTRUCTION <br />everett PERMIT E+ <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION <br />JYBUILDING <br />❑ MECHANICAL <br />❑ PLUMBINCIKI+ <br />.❑ SIGN <br />owl' A <br />AGGRESS <br />CITY ZIP <br />PHONE or <br />x - 11 (pio <br />JJ%iL'.t'Ei?! //(//�L.VIE•/>FnJ <br />129CE1 <br />5_`1 y PA'S& <br />EvY-XEE% !G/9sff <br />9,'1-" 337-/K,A-f,_ <br />�DNITECT OR pES101IER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />ZH r'A�55F o,1/ L7Es'15!nr <br />2z29 <br />OE/N�EMLCONTMLipq <br />MMI AODITE99 <br />CgEJSi <br />C'ry 21P <br />PHONE <br />• <br />LICENSE• <br />NRs..: •c <br />A % /Q ..Su�/>•.tCSn.✓ <br />Rf.Y70,y <br />aoS70 <br />sr- S:ci .0 yrt.;E�rn� <br />yd Deb b9s-s' <br />775 <br />i E3 uA <br />MECHANICAL CONTnACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMFRN(I CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />A NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCA110N <br />VALUATION of WOnKICO9T OF MATERIALS PLUSLABON <br />' IVLV `f =0 <br />DESCRIBE WORK �- <br />rc, Als-lxuft ,�62 ru ,r..E, r <br />USE OF BUILDING <br />J/ <6 FAtif�r /?ES/UE�-tiCC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIHEU THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSANO ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETED WITH WHETHER SPEClF1EDHERE- <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 COASTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGE DATE <br />X /� 3 3/6 6 <br />LEGAL DESCRIPTION ZOFFPPROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />Lo-elocy /YVOF r9L <br />7.P !^ LvC 44 <br />A{.P.<OC. ,T o 4 .4.4 cs <br />,9 C- f9 r _ S G[/ <br />PROJECT ADDRESS�l <br />APPLIC PSCITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />WATER CLOSET IT51LE <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />RLFRIGE9ATION UNITS—H P. EA. <br />LAVATORYIWASH BASINT <br />OO <br />BOILEHS—H.P. EA, <br />SHOWER <br />GAS FIRED AC UNITS —TONNAGE EA <br />KITCHEN SINK { DEEP. <br />BO <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />iS <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <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—RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />SINKSSE RVICE—BAR, ETC. <br />WOODSTOVE/ FIREPLACE INSERT <br />SUBTOTAL <br />tR7 <br />SUBTOTAL <br />PERMIT { <br />PERMIT <br />TOTAL FEE { <br />D <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />,=;� JI <br />USE ZONE <br />�_ <br />TYPE OF CONST <br />I)- ") <br />SIZE OT BL DO <br />F' - I Oro J r <br />EIBACK <br />SIDE SETBACK <br />r � <br />EA <br />VACANT SITE <br />()n P Rpm <br />DYES ONO <br />ANCY GnOUP <br />NO OF DWELLING UNITS <br />f? - 3 <br />1 <br />STORIES <br />I <br />MAX OCC LOAD <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />APPLICATION <br />APPn Pon ISSUANCE <br />PLAN CHIECK NUMBER <br />A/^ I(� <br />U u� J <br />(0 <br />P.AN CH[CK EEE <br />FEE RECEIPT NO <br />, Ty 7 — <br />FEES I <br />VALUATIOU <br />FEE <br />BUILDING <br />E 3so�+L9, <br />PLUMBING <br />MECHANICAL <br />O <br />OTIIEn <br />PENALTY <br />TOTAL <br />+ <br />24 I <br />T <br />SD <br />9 <br />f/Y <br />