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&# PLICATION FOR <br />07YOF "" CONSTRUCTION we <br />uTr of <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />�tl5 3_SZ- U/d`% <br />❑ DEMOLITION O.COMBINATION AUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />� L L oaks /a y2/ . 1/ 2r 1, - S.c: 12011 337- 79�16 <br />GENERAL GONiRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />ys/�✓ Asp <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />COY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />L A VF WVtln <br />NEW ❑ ADDITION ❑ ALTZRATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />Ut �MAIAnIALa VLV:L UnI <br />QG02 . <br />(JLJ <br />USE OF BUILDING <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 />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 />ANY OTHERSTATE ORLOCAL LAW REGULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATU OF RAC.T�OR,.OR AUTHORIZED AGENT OA7TE <br />A y <br />LEG�xPIPTION GF PROPERTY ISM' NOEL OW OP ATTACH FOURCOPIESI <br />11////`Lnn�� F/ .5 �U - <br />L BLocK—oF <br />DjjFj • _ i6E' <br />/� <br />C o� fA - � <br />-2-}.y/nr� <br />F.c-wo.T.Cgra7 <br />GlriY� /i*� ,r?, I <br />Y <br />ECT DDRE`S�S GGD,�rs <br />_ <br />JL#yPLICANrS 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(TOILET) <br />AIR COND. UNITS-H.P. EA. <br />_ <br />I <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />_ <br />7- <br />LAVATORY WASH BASIN <br />BOILERS-H.P. EA. <br />( <br />SHOWER <br />5_00 <br />GAS FIRED AC. UNITS -TONNAGE EA <br />/ <br />KITCHEN SINK A DISP. <br />00FORCED <br />AIR SYSTEMS-B.T.U. M EA. <br />/ <br />DISHWASHER <br />a.LWALL <br />HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HF-ATERS-B.T.U. M <br />I <br />CLOTHES WASHER <br />'j <br />EVAPORATIVE COOLERS <br />-4- <br />R <br />/ <br />CLOTHES DRYERS <br />URINAL - <br />.3 <br />VENTILATION FAN <br />Ls <br />5-CL <br />DRINKING FOUNTAIN <br />/ <br />RANGE HCOD <br />FLOOR DRAIN' <br />AIR HANDLING UNIT- C,F IA. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />so <br />vo <br />SINK SERVICE -BAR ETC. <br />WOOOSTOVE/FIREPLACE INSERT <br />i//AF2'Tc E471E C- <br />SUB TOTAL <br />EU <br />SUB TOTAL f <br />I03 <br />IX� <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONTSETBACK <br />�'Sll <br />REAR SETBACK <br />a�Y <br />SIDE SETBACK <br />S� <br />PLAN CHECl/S NUMBER <br />/ / / I :% j <br />CJ i <br />�PL�AN <br />FEE �>L I <br />OIT <br />CHECKFEE <br />RECEIPT NO. & �-]� <br />(fl / <br />USEZONE <br />- <br />LOT AREA aZ[� <br />VACANT SITE <br />NES ONO <br />FEES <br />FEES <br />VALUATION <br />FEE <br />TYPE OF 0 T-� <br />OCCUP� GROUP <br />3 <br />NO, OF DWELLING UNITS <br />I <br />BUILDING <br />s.5zfemQJ <br />427) <br />SIZE OF BLDO (� <br />NO. OF STORIES <br />MAX OCC.LOAD <br />9,4, <br />PLUMBING <br />S <br />oo <br />FIRE SPRINKLERS REQUIRED O YES NO <br />MECHANICAL <br />OTHER <br />/ <br />00 <br />00 <br />PENALTY <br />!ya <br />o_ <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />q <br />IL/:JK� <br />APPR. FOR ISSUANCE BY <br />(_ _ G • <br />TOTAL <br />a <br />— <br />