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APPLICATION FOR <br />OF C EY'"°r"° <br />clTr CONSTRUCTION everetl <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING 0 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER / MAIL ADDRESS CITY ZIP PHONE <br />MAIL ADDRESS <br />MAIL <br />ZIP • PHONE <br />yHONE <br />LICENSE <br />PLUMBING CONTRACTOR MAIL AUURE55 Oln 41P PIIUNE LIPCaE• <br />Z4/ <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />OF WOnK <br />/F.Y'.Nif %/^ /AiL�iS�%IIC %.�LLr�i /ir✓ <br />USE OF BUILDING <br />T <br />ei�jrlr <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />AND KNOW THE SAME TO BE TRUE ANDCORRECT. 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 CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X ? <br />LEGALDF.SGRIPTIONO°PR PERTY(SHOWN OELOW OR AITACN FOUR COPIES( <br />Lol_D:OCK_—OF_ <br />PROJECT ADDRESS <br />PLUMBING <br />APPLICANTS CITY BUSINESS LICENSE NO <br />37 <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 — H.P. <br />BATHTUB <br />REFRIGERATION UNITS —11 P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U./H P. <br />SHOWER <br />GAS FIRED A.C. UNITS—B.T.U. <br />KITfHEN SINK A DISP. <br />_ <br />FORCED AIR SYSTEMS — 0 T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHESORYERS <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 ISERVICF. — BAR. ETC.) <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />S <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FeE <br />PLAN CH CK NUMBER <br />?g 119�a <br />FEE <br />(0,4 <br />RECEIPT NO. <br />G5,54 <br />FnONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />�!I <br />LOTAREA. <br />/ <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S Cj Y <br />D <br />ttPE OF CONST. <br />OCCUPAN�.Y GROUP <br />A:J/- Z <br />NO.OF'DWELLING UNITS <br />.0e <br />PLUMBING <br />SIZE OF BLDG� I <br />J�Ffj <br />NO. OF STORIES <br />MAX. OCC. LOAD <br />MECHANICAL <br />FIRE SPRINKLERS RESIb"ED 4YES O <br />OTHER <br />STATE BUILDING SURCHARGE <br />3 <br />SQ <br />AP" CATIONACC BY PLA.NSCHECKED BY APPR FOR ISSUANCE BY <br />�II <br />1 <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />i <br />PROPERTY OWNERS ARE RESPUNS)BLE FUR Ut I EHMININU ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />