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?PLICATION FO( We <br />Of <br />mn <br />CInor CONSTRUCTION a <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL. AOORE55 CITY ZIP PHONE <br />rn GM55 x PROS i sc, evo-c NtmJ wy <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADDRESS /IN/Af1UOJp CITY �2ONE LICENSE <br />u <br />rZonn Al"pi INC!NC P P ex S26q / w�� ��L B&" IJX1Y <br />MACAL CONTRACTOR <br />ECHNI <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />uGENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />. rl% rd- I,, I....A,Am-» <' /IA/ 6A/ , viCrlur 17IPES <br />USE OF BUILDING <br />469mmoLC <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BETRUEAND CORRECT. ALL <br />PROVISIONSOF LAWSAND 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 />SIGNATUR OF CONTRACTOR OR THORIZE AGFNT DATE <br />Xft, _f2j /7 YP <br />LEGAL DESCRIPTION OF PROPERTYI5NOWN BELOW ORATTACH FOURCOPIESI <br />LOT —BLOCK OF <br />PROJCCT ADDRESS <br />1 SE. rvcfz'e- r MA'I-t wy' <br />APPLICANTS CITY BUSINE 55 LICENSE NO <br />9 3 _Sb <br />PLUMBING <br />MECHANICAL <br />TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />IN <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS -RR EA. <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />, <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M FA. <br />DISHWASHER <br />_ <br />WALL HEATERS—B.T.U, M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />LLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLL..DERS <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />SINK SERVICE —BAR, ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />_ <br />TOTAL FEE f <br />1 <br />1 <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SITESETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF C.ONST. <br />OCCUPANCY GROUP <br />1 <br />NO, OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBIN3 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECH\NICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />I / <br />, \ <br />PLANSCHECKED BY <br />/ <br />APPR FOR ISSUANCE BY <br />�� <br />TOTAL <br />