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.PPLICATION FO B„ <br />the CITY OF "" CONSTRUCTION. <br />clry of <br />ev erett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />DWNER MAIL ADDRESS 11,CRV ZIP PHONE <br />ortaw n cc CITY ZIP PHONE <br />LICENSE <br />MECHAN IO ALLLI OON TRACTOfl MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE• <br />e_1_-.-1,_ 11 #I'Y-- <br />❑„NEW y^^❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />y,�LWN OF WORK(COST OF MATERIALS PLUS LABOR) <br />IO11Go0o rnCJC �ISOrQ '/1i0 ng n Inc% 6paLZ I nuo tSLCpz� 1_T,k <br />DESCRIBE WORK <br />USE OFBUILDING <br />L <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />.Ju�45 <br />PLICATIONAND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION Of PROPERTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />OF WORK WILLBE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT_BLOCK —_OF_ <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 AUTHORIZED AGENT DATE <br />X �O,{R� <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />1�1� c 1 <br />Oricl, 1 <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 />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />LAVATORY (WASH BAST NI <br />BOILERS—H.P. EA. <br />_ <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UN14 C.F.M. <br />VACUUM BREAKE <br />STOVE <br />ROOF DRAINS— AINLEADERS <br />METAL FIREP CE & CHIMNEY <br />SINK SERVIC —BAR, ETC. <br />WOODSTOV /FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE $ <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN LIIECK11 <br />NUMBER <br />PUN <br />FEE t]/ _ ( <br />CHECK FEE <br />RECEIPT NO <br />J/V <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />I{ <br />V <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCO LO , <br />^3 r) <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED 14YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />I I <br />PLA CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />