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the EYarpnnn `• .PPLICATION FO►_ " [ver'eh <br />CITY OF CONSTRUCTION <br />evereti. PERMIT e <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING Cl SIGN <br />OWN R MAIL ADDRESS CITY ZIP PHONE <br />�[.� (• iu,,l`IisT�L� �a`fioC , . �r7-,0� � ur,.•sc �� �11LL4 L UJ(Ltr <br />ARCHJECT OR DESIGNER MAILAUDRESS I ZIP PHONE <br />GENERAL CONiRAC:1JP MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MLG11AINCAL CONP'¢CTUR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />l(a7•ps Ou-t') Dr, �u�.sLN 98a01 <br />PLUMBING CONTRACTOR MAIL ADDRESS IN ZIP PHONE I LICENSE• <br />CU5501 WORN <br />NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />ul ennu nlm:I vl ua l nw nn <br />a C'(' <br />Il Q 1- <br />I - 1 �I-I. - <br />- <br />•. 2 � <br />LIST: or BwI DING <br />I HEREBY CERTIFY THAT I WAVE EAD AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF 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 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DFSCRIPDON OF PROPERTYISHOWN BELOWOR ATTACH FOURCOPIESI <br />LOI—aLOCK—OF <br />PROJECT ADDRESS <br />II,�Dv� IyLE,�l,l, <br />I;�+f>� �,�. 4�uo-ac.l� (11LT1 Q •�inL <br />- _ <br />APPLICAr TS CITY INESS LICENSE NO <br />_r�y7 <br />PLUMBING I <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 />I <br />REFRIGERATION UNITS—H. P. FA, <br />_ <br />LAVATORY (WASH BASIN( <br />BOILERS-H.P. F.A. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA, <br />KITCHEN SINK 8 DISP, <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL NEATENS—B.T.U. M <br />LAUNORYTRAY <br />UNN HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />_ <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 />STOVE <br />_ <br />ROOF DRAINS —FAINT EADERS <br />METAL FIRFPLACE A CHIMNEY <br />SINK ISERVICE—BAR, ETC.( <br />_^ <br />WOODSTOVE,FIREPl. ACE IN ERT <br />_ <br />SUB TOTAL <br />_ SUBTOTAL 5 <br />PERMIT $ <br />PERMIT s <br />TOTAL FEE <br />TOTAL FEE _ s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />�unnE,a,Lnn <br />USE ZONE <br />TYPE OF CONST <br />APPI ICATIO14 ACC BY <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />LOT AREA VACANT SITE <br />FEES VALUATION I FEE <br />OYES ONO <br />— <br />GROUP <br />NO, OF DWELLING UNITS <br />_ <br />BUILD:NO S <br />IES <br />MAX_ OCC. LOAD <br />PLUMBING <br />S ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />KED BY <br />APPN. FOR ISSUANCE BY <br />TOTAL <br />