Laserfiche WebLink
,�.Ew,o,,,� �PPLICATION FO� ;,��,�„ <br /> ��TM�F C(3N15TRUCTIAN � <br /> everett PERMIT <br /> 1„ BE COMPLETED IN BLACK INK— PLEASE PRINT <br /> BUILDIN3 DEPT. <br /> 259•8745 ❑ CQMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBING � SIGN <br /> OWNEP M�Ill1D�PE94 GITY L'P PMONF. <br /> .5�t✓E.3oa�(Aic sr�2 �ia-o) /a�z/ .E-d.�,e�,�,J ��' .���%7 sbza� 3�s3 - -�i7iz <br /> •RCNIIECTGADE310NEP �ILA�ORE39 CITY 2�V PMONE <br /> OENENALCONTHAGTON M�ILADORE9S CITY ZIP PHONE 4CENSE• <br /> C�iTY s�c,✓,�.�di�c O1.�X zz�� r_'vF.ef-�i t�,a- 5'Yza3 3�'-r�zby�l c�rr.��SaaK <br /> MECH�NICQCONfMCTOq MAILADpRE79 CITY ZIP PMONE 4CEN9E� <br /> PWMBINOCONIN�C70R M�IL�DDHESS CITY 21P VIIONE 4CENSC• <br /> CL�SS OF WUPK <br /> � NEW ❑ ADDITION ❑ ALTERATIO� ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVc�'rRPL.INSERT ❑ BUILDING RELOCATION <br /> V�LU�f10 FWORN�C09TOFMRtERUL9PLV5LABOR) <br /> ZOa. � <br /> DESCPI9E WOHR <br /> zur.qcc. Sry.¢v re�.y usirERs o.� d�,w..a6 cJRcc- <br /> use oF euaoiHa <br /> /���� I HEREBY CERTIFY THAT I HF.VE READ AND EXAMINED THIS AP• <br /> _(�/DEO .�r.JrAt d PLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALI <br /> lEGA1.OE5GNIP110NOFPPOPER1Y15110WNBELOWOP.RTTRCHFOURCOPIES} pROVIS�ONSOFLAWSANDOR`11NANCESGOVERNINGTNISTYPE <br /> OF WORK WILL BECOMPLETE�WITIi WHETfiEflSPECIFIE�HERE- <br /> lOI-BLOCK-OF IN OR NOT.THE GRANTING OFA PERMIT DOES NOT PFESUME TG <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> --- OR TH[ PERFOFiMANCE OF CONSTRUCTION. <br /> SIONATUFE J .ONTRACTOR OR AU/TIIOfiIZE[1 AOENT DAiE <br /> XK//'1?w.L Y-��-��7 <br /> PROJELi AOOfiE55 APPLICNNiS CITY BUSINESS LICENSE NO. <br /> /d/Z/ EdE/L6k ,J CJ.4 ?/_FPf-7f GJq -l�'.yYo /lv �0(c <br /> PLUMBIN6 �1ECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. T'PE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE71 AIR COND.UNITS—H.P.EA. <br /> BATHTUB REFRIGERATION UNITS—N.P.EA. <br /> IAVATORV�WASH BASIN) BOILERS—H.P.EA. <br /> SHOWER GAS FIRED AC.UNIiS—TONNAGE Eh <br /> KIiCHEN SINK 8 DISP. FORCED AIR SVSTEMS—N.T.U. M EA <br /> DISHWASHER N'.1LL HEATF.RS-9.T.U. M <br /> LAUNOflY7RAY UNITHEATERS—B.T.U. M __ <br /> CLOTHES WASHER EVAPORATIVE COOLEFS _ <br /> WATEfl HEATER CLOTHES ORYEFS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUN7AIN RANGE HOOD <br /> FLOOR DRAIN AIR HANOLING UNIT— C.F.M. _ <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEAOERS ME7AL FIFEPLACE 8 CHIMNEV __ <br /> SINK SERVICE—BAR.ETC. WOODSTOVE/FIREPLACE INSERT <br /> SUBTOTAL EUB TO7AL S __ <br /> PERMIT S PERMIi S <br /> TOTALFEE S TOTALFEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FHONTSEIB�CK BEARSET9ACN SIDESET9ACK PLANCHECKNUI.I�ER FLANGIR"CKFEE <br /> FEE AFCEIPt N0. <br /> . USE ZONE LOT FRE� ypCANT SITE <br /> OYES pH0 FEES VALU�TION FEE _� <br /> TYPEOFCONST. OCCUPpNGYGIlOUP NO.OFDWELlINOUNITS <br /> BUILDINO f <br /> SRE OF BLDO. NO.OF STOf11E3 MAX OCC.LOAU -- <br /> PLUMBINO <br /> MECHANIC/.L <br /> FIRE SPRINKlERS RE�UIRED O YES O NO <br /> OTMER <br /> PENAI.TY <br /> �PPLICAtION�GC.BY PLANSCIIECNEOBY pPPR.FOBISSU�NCEBY --- <br /> TOTAL <br /> � � � _ <br /> � <br />