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i�PLICATION FOh <br />The EYerpraen CONSTRUCTIONCRY OF <br />Cverett PERMIT <br />T7 BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />everett , <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE II <br />2l�eg{ Cd bcnLl—C4 IqO L E4ftF>rirLwu (-JA14 k✓tic;r Ilryl <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CHY u. - <br />s Iq 1.1 <br />ia- .L/4•k.-"I1=RTo- //.I-mitko(t- hoc No Strt G6109 C�3-'{-L/1--(3 MEyE.ers.L4e <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHOti- LICENSE♦ <br />DO NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF M4TERIALS PLUS LABORI <br />I L(OC) <br />I wl c -.--1._, 1 -1 Si r- I le o- (-.J A-L.L_ S 1 ET .-1 i <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVM READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I 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 Ole <br />CONSTRUCTION <br />ANY HE ER STATE FORWA R LOCAL LAW CONSTRUCTION. <br />OR THE PERFORT:,aN-^.E OF CONSTRUCTION. <br />SIGNATUR rOFOw"c*oR OR AUTHORIZED AGENT DATE <br />-y <br />ulbw <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK _—OF <br />— <br />PROJECT ADDRESS <br />IL•(U a- "s ve-.1,E T m L7 <br />:''J All :.; i v Pct1NESS LICENSE N0. <br />3 3L11 l <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA <br />_ <br />LAVATORY WASH BASIN <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK& DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-S.T.U. M <br />CLOTHES WASHEP. <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE & CHIMNEY <br />SINK(SE ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL & <br />PERMIT S <br />PERMIT & <br />TOTAL FEE $ <br />TOTAL FEE & <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR <br />USEZONE ♦LOT AREA (VACANT SITE <br />OYES ONO <br />TYPE OFCONST. IOCCUPANCYGROUP I NO. OF DWELLING UNITS <br />MAX OCC LOAD <br />BY <br />PLAN <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE I RECEIPT NO. <br />FEES I VALUATION I FEE <br />S <br />