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1�o W"n KePLICATION FOB EYlTEII <br />CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />7 !1EMOLITIION <br />❑ COMBINATION <br />VkBUILDING <br />❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />�%/ Q/V �7�j7 <br />/h t )v D. <br />/� <br />Uok 3 2 <br />yfr rwcvr) fAn <br />3G ? ?9 <br />-00C;y <br />R NITEC OROESIONER <br />_/1 <br />MAIL ADDRESS <br />,Iz <br />/� ,/ <br />ZIP' <br />PHONE <br />., I <br />//nnV .7D&NSa <br />/���'/ <br />.23 Nly SeQ771e <br />5 yE-.22YP <br />GENERAL CONTRACTORr <br />/ \AIL AODRE'S <br />CITY ZIP <br />PHONE <br />LICENSE - <br />CITY ZIP <br />LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS OF WORK <br />10 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR PL. INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK COST OF MATERIALS PLI IS LABORI 0 <br />V<TrHIOC AVI1.� .1 <br />�/--G//Ch- <br />- <br />usEOFBUILDING SId.OL�C.Ci 1 M',W/L-Y /Je� <br />'`- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXP. DNED THIS AP- <br />PLICATIONAND KNOW THE SAME 'iOBETRUE AWICORRECT. ALL <br />PROVISION 3 OF LAV/S AND ORDIIIANCES GOVERNING THIS TYPE <br />OF WORK WILL LIE COMPLETED WITH WHETHER SPECIFIED hiERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORI"r TO VIOLA'E OR CANCEL THE PROVISI'DNS OF <br />ANY OTHER STITEORLOCAL LAW REGULATING CONSTR')CTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OFPROPERTYISHOWN BELOW ORATTACH FOURCOPIESI <br />CbT—eL w S / LJ - W C T <br />AJ VV <br />PROJJJIVJCCT�Aj�DDDRRESS } <br />V1©✓ <br />APPLICAN CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />/ <br />AIR COND. UNITS-H.P. EA. <br />- <br />BATHTUB <br />O <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY WASH BAJIN <br />QUO <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK a DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B T.U. M <br />' <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />/ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />lob <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— G.F.M. <br />VACUI M BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />I <br />METAL FIREPLACE a CHIMNEY <br />SINK SERVICE —BAR ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />_ <br />TOTALFEE f <br />7OT.AL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL_ <br />VT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />Z NZ NE <br />LOT AREA <br />VA ANT SITE <br />L <br />q')( .7F <br />YIIS ONO <br />OF CONST. <br />OCCUPANCY GROUP <br />NO. OF OWELLIN <br />OF BLOC <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />;ATION ACC. BY PLANSCHECKED BY APPR FORISSUANC <br />)14 Wl s� L . L. <br />PLAN CI.cCK DN/NIDER PLAN CHECK FEE ////J <br />S(I Ow FEE ��� Ff IPECEIPT NO O/ 3 <br />FEES VALUATION FEEDFEE9 FEE <br />�i I Ifl� <br />BUILDING f <br />PLUMBING <br />MECHANICAL <br />OTHER 01l /I (/( J <br />PENALTY---��IT}��/�� <br />TOTAL '�1 7 1 I! 71 / <br />. .. - Y• .. <br />