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fA. Ewrgiw -`PPLICATION_ FQ¢- - - <br />DRYDP CONSTRUCTION M Ce <br />everett PERMIT <br />L <br />BUILDING DEPARTMENT M <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAILADDRESS CITY ZIP J(SIGN <br />PHONE <br />4gy mzgT- d-s,)v0.4 2. I ts- sL'J Ct/Tr Mft-L L, 4-y ry7r <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY <br />ZIP PHONE LCENSE s <br />LQ8►Z/ZY N�^�✓ Cp 2rvc PP. iB/x b�2C9 LYM� ar9 :C/'Sv'fG BenFCYIu.I cd <br />MECHANICAL CONTRACTOR MAII Anncccc <br />"""•'- LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP <br />PRONE LICENSE <br />CLASS OF WORK <br />A NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK MOST OF MATERIALS PLUS LABOR( <br />_ ♦YA F/ IL�i �6 <br />DESCRI WORK <br />7 / F S <br />% S/F //-J 7 :.a I �✓r. _ LVryI4—NF �. <br />USE OF BUILDING <br />— Ufv OFVO J.Lo/v VLpJ3y� FI, PtLOAI` ST610 <br />C040e ft,ccrp-ty fir/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATIONAND K.NOWTHESAME TOBETRUE AND CORRECT. ALL <br />LEGALDESCRIPTION OFPNOPERTYISNOWNBELOW ORATTACH FOUR COPIEST <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING <br />LOT —BLOCK. —OF <br />THIS TYPE <br />OFVL✓RK 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 <br />THE PROVISIONS Or ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CO TRACTOR OR AUTHORIZED AGENT DATESq <br />PROJECT ADDRESS <br />L Q 1 jQQ7 <br />/G <br />APPLICANT' TY BUS NESS LICLGSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />TYPE OF EQUIPMENT <br />AIR COND. UNITS—H.P. EA. <br />UNITS—N. P. EA. <br />FEE <br />— <br />BATHTUB <br />LAVATORY (WASH DASIBASIN)REFRIGERATION <br />SHOWER <br />SHOWER <br />KITCHEN SINK 8 DISP, <br />DISHWASHER <br />BOILERS—H.P. EA. <br />GAS FIRED AC. UNITS —TONNAGE EA <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />LAUNDRY <br />WALLHEATERS <br />TRAY <br />CLOTHES WASHER <br />UNITHEATERS M <br />EVAPORATIVE COOLERS <br />--- <br />WATER HEATER <br />CLO'HES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />RANGE HOOD <br />AIR HANDLING UNIT— C.F.M. <br />'— <br />VACUUM BREAKERS_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />SINK SERVICE —BAR. ETC. <br />METAL FIREPLACE 8 CHIMNEY <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL s <br />PERMIT >f <br />PERMIT s <br />TOTAL FEE i <br />TOTAL FEE s <br />THIS <br />FRONT SETBACK <br />PORTION TO BE <br />REAR SETBACK <br />COMPLETED <br />SIDE SETBACK <br />BY BUILDING DEPT. <br />PLAN CHECK NUMBER <br />PERSONNEL <br />PLAN CHECK FEE <br />FEE RECEIPT NO, <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANLY GROUP <br />NO.OF DWELLING UIIITS <br />BUILDING <br />S <br />SIZE OF SLUG. <br />NO. OF STORIES <br />MAX OCC, LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED DYES C NO <br />MECHANICAL <br />OTHER <br />PENALTY - — <br />APPLICATION ACC BY <br />PLANS CtMUKEU BY <br />APPR. FOR ISSUANCE BY <br />/•' <br />TOTAL <br />a <br />