Laserfiche WebLink
APPLICATION FOW <br />OF CONSTRUCTION e <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑, COL48INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGA <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />09NEPALCONWTOR MAI. ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WIOIIL- <br />® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />L /J. Aav t1r <br />11•E Of NIADKq - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORD INANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHCRSTATE ORLOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORtZED AGENT DATE <br />LEGAL DEfCMPTION OF MIPERTY(SHOWN BELOW OR ATTACH rqup gowee�„� ,# <br />Jti'• <br />Lor�eLocN..�—oF <br />pJZ <br />PROJECT ADDIIESS <br />laa ,a- <br />FLUMMING <br />APPLI NTSCIW BUSINESS LICENSE NO. <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 />4W <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORYIWASH BASIN) <br />BOILERS-M.P. EA <br />SM NER <br />GAS FIRED AG UNITS -TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA a <br />- <br />DISHWASHER <br />CD <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />I <br />STOVE <br />ROOF DRAINS-RA(NLEADERS <br />METAL FIREPLACE f CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />BUM TOTAL <br />— <br />— <br />— <br />_SUBTOTAL ____. f✓OQI�_ <br />PERMIT • <br />_ <br />--_ <br />PERMIT • <br />TOTALFEE M <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />( REAR SETBACK S1DE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />( / � 41f3 fEE LL i�cRECEIPT!2,0 <br />LOTAR A VACANT SIIE of <br />FEES VALUATION FEE <br />K- G <br />�`/ /Q1 Sr <br />OVE8 ONO <br />'Pt O'F�/ STw. <br />i J'v <br />CUPAN OCYYGROUP <br />` , <br />NO. DWELLING UNITS <br />2 <br />BUILDING <br />ZE OF BLDG. <br />NO. OF STORIES <br />MAIL OCTL' <br />O <br />PLUMBING <br />IRE SPRINKLERS REQUIRED ❑ YES 14 NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />WLICATION ACC. BY <br />PLANS CHECKED BY <br />it <br />APPR FOR ISSUANCE BY <br />L•G• <br />TOTAL <br />