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�►�tiYM <br />4PLICATION 1`01 � <br />BYEF•M <br />'" <br />CONSTRUCTION <br />e <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ® COMBINATION <br />O BUILDING O MECHANICAL <br />O PLUMBING <br />❑ SIGN <br />ORMER <br />-%NA/ eLA/60otN,[ <br />MAIL ADDRESS � CITY ZIP <br />��/�� FfOIJSL .s+v�- EG't-RRrT 9rz6l <br />PHONE <br />2SZ-9S3*" <br />ARCHITECT OR DESKINER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />MECHANICALCONTRACTO4 <br />MAIL ADDRESS .CITY ZIP <br />PHONE <br />LICENSE- <br />PLUMBING CONTRACT pI <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE - <br />CUSS OF WORN <br />❑ NEW CZ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LAOM <br />DE IBE woRN <br />AAA 'I Rin/nwn.c A1APTAY . i.9uv0RV //L71/h <br />Roil L AJ4/--VVI- IVY/I <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OR ATTACH FOUR COPIES) <br />LEGAL DESCRIPTION OF PROPER1C�jNOO B <br />Z?/Zlf/Z? �� <br />OFWORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE - <br />19 v!ELOW <br />LOT —BLOC of j �v i`i <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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNAT E OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESS <br />LICANTS CItY BUSINESS LICENSE N0 <br />PLUMBING <br />MECHANICAL <br />_ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET <br />m <br />AIR COND. UNITS-H.P. EA <br />_ <br />BATHTUB <br />W <br />REFRIGERATION UNITS-H.P. EA <br />_ <br />LAVATORY JWASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />LO <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK f DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />S <br />UNIT HEATERS-B.T.U. M <br />_ <br />I <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />b� <br />URINAL <br />VENTILATION FAN <br />LID <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />i� <br />F <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />, <br />METAL FIREPLACE • CHIMNEY <br />SINK SERVICE -BAR. ETC. <br />`. <br />F <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />p. <br />3� <br />SUB TOTAL <br />SUB TOTAL f <br />_ <br />5 <br />PERMIT f <br />PERMIT • <br />TOTALFEE •PEA <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />i✓ ^^0 <br />BIDE SETBACK <br />PLAN CHECK NUMBER <br />` <br />! PLAN <br />FEE Cam <br />✓VALUATION <br />CHECK FEE <br />RECEIPT NO 7F7/4 — <br />`� 7 <br />USEZONE <br />/� _ / <br />LOT AREA <br />N- <br />VACANT VACANT TE <br />OYES AD <br />FEE! <br />FEE <br />TYPE OF,, CIIONS/T 1/ <br />OCCUPA,N(�/,Y GPzOUP <br />'1 �J <br />NO, OF DWELLING UNITS <br />/ <br />BUILDING <br />SIZE OF •. F� T <br />N <br />NO. OF STORIES <br />Z <br />MAK OCG LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED D YES D NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />- � <br />TOTAL <br />�r� J <br />