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iPPFICATION F4_. r6l <br />^fEOF "° CONSTRUCTION <br />everett PERMIT <br />BUILDING DCPAFTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />Ejr'EHAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />�julv11 1U y`iI 0,° �r Ifi <br />MLCIIANICAI CONTRACTDq `• - MAIL ADDRESS CITY ZIP PHONE I ICENSE A <br />I'I(d\I,:,b (31G-. �Allall . IID7v7 F..nov4v _ UVe j or, tag L-)g n1 <br />PLISMWNG CON TRACTOR II L MAIL ADDRESS C.tt ZIP (PHONE LICENSLA <br />ClAAAoS III WINK <br />\L4 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOIE/FRPLANSERT ❑ 13UILDING RELOCATION <br />VAILANOI. JF WORKICOSI Fpr MATERIALS PLUS LABORI <br />Jul- �A �.Q _ LA_,y1A i <br />�1k0.'� Lt. C , 4 t <br />USE OF UUIL DING <br />I EflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />AP CATIONAND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUNIF 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 />LFGM. DESCRIPTION OF PROPERTYIPeOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BIOCK—_OF - <br />PROJECT ADDRESS <br />I,gDJ $L F-VPIL4 tool ('JQL <br />APPLIC NTSCITY &SINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET ((OILET) <br />.AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA. <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />GOILERS-H. P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. _ <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />1 ll. <br />CLOTHES WASHER <br />EVAPORAT'NE COOLERS_ <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- GEM. <br />_ <br />VACUUM BREAKERS <br />`DOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK(SERVICE-BAR. ETC.) <br />_ <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />✓SUB <br />-- <br />SUB TOTAL_ <br />TOTAL S <br />D� <br />_ <br />PERMIT 5 <br />PERMIT 5 <br />coo <br />TOTALFEE $ <br />TOTAL FEE f <br />C- <br />o'_ <br />THIS PORTION TC BE COMPLETED BY BUILDING DEPT., PERSONNEL <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />LOT AREA VACANT SITE <br />FEES VALUATION FEE <br />OYES ONO - <br />OCCUPANCY GROUP NO. O F DWELLINGUNITS <br />BUILDING E <br />NO. OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />:RS REQUIRED ❑ YES ❑ NO <br />OTHER <br />_ PENALTY <br />BY FI ANS CHECKED BY APPR FOR ISSUANCE BY <br />TOTAL <br />