Laserfiche WebLink
I PPLICATION FORAJI <br />BYL.Fe„ <br />crO"""' CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY 21P PHONE <br />To�,.Yslo� �TroleAw. <br />a-73/ rec�ecal rued yyzor asd-i/79 <br />Cltt ZIP PHONE <br />CITY ZIP PHONE LICENSE <br />PLUMBING CON] RAOTGR MAIL AODRES9 . <br />❑J NEWV ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT <br />LABOR( <br />DESCRIS WORM L, )IIIIA /n T__ Tle 1CI <br />BUILDING RELOCATION <br />kLISEQOF1 .BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION ANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br />PROVISIONS OF LAWS AND 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 OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF ONSTRUCTION. <br />SI TURE OF CONT ACTOR O NO ED AGENT DATE <br />BELOWORA <br />LEGAL DESZRIPTION OF PROPERTY(5HOWN ITACH FOUR COPIESI <br />rr��j��F/..�I�� Diu <br />�...�—.ilL— <br />LOI_BLOC�OF_, <br />PROJECT ADDRESS <br />.2731 mac. ccai <br />, I.cf e-Ti <br />APPLICANTSU IN SS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS - N.P. <br />BATHTUB <br />REFRIGERATION UNITS -HP. EA. <br />LAVATORY (WASH BASINI <br />BOILERS - B.T.0 /H.P. <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK A OISP. <br />FORCED AIR SYSTEMS -B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNORYTRAY <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 PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE ` <br />SINK (SERVICE - BAR. ETC( <br />fit+ <br />METAL FIREPLACE B CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SUB TOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMLT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />_' <br />LOT AREA <br />6000 <br />VACANT SPE <br />OYES ONO <br />FEES <br />VALUATION <br />iEE <br />BUILDING <br />TYPE OF CONST <br />:- K <br />OCCUPANCY GROUP <br />e - Z <br />NO, OF DWELLING UNITS <br />-0— <br />PLUMBING <br />SIZE OF BLDG <br />/620 <br />NO OF STORIES <br />MAX. OCC LOAD <br />iili¢ <br />MECHANICAL <br />OTHER <br />AZvv'WDAQ77doX <br />FIRE SPRINKLERS REQUIRED ❑ YES XNO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />dW <br />PUNS CHECKED BY <br />APPR FOR 15SUANCE BY <br />�' <br />PUBLICWORKS <br />TOTAL <br />rno nrtreuuuun Al I <br />�lIME3',is. X� 2�y u�ILL <br />YHL,YC, Vm..-rv�..._..__. _.._ <br />PROPERTY LINE LOCATIONSAND RELATED EASEMENTS <br />jp.Ot� ,d�ej,&6_al�Fxeyto.c <br />