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A'PLICATION FOR.:.> <br />Ow '"" <br />CRYOF CONSTRUCTION <br />DRY O <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION C COMBINATION ❑ BUILDING C MECHANICAL <br />❑ PLUMBING <br />f ` i <br />' EYIlTtll �`: <br />:C1 SIGN <br />PIUMBINOCONTPACIOR MAIL ADDRESS CITY ZIP PIIONE LICENSE <br />CL ]Or nvna <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />I, jj��O - ./ 1VU <br />DESCRIBE WORK <br />L __IL.-LL 11W__„J CWP CVii M.,. <br />USE BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED.THIS AP• <br />LJ <br />i� <br />PLICATIONAND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNI NG THIS TYPE <br />LEGAL bESCRIPTION OF PROPERfYISNOWN DELOW OR AItAC11 FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOI_. 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 PE FORMANCE OF CONSTRUCTION. .., <br />SIGNAIUPE01 ONTRACTORORAUTHORIZED AGENT DATE ,A•, ` <br />PROJECT�T ADDRLSS <br />AP LICA S-.1TY U INESS LICENSEAtE NO �( zo 1 <br />SE � f - <br />PLUMBING <br />MECHANICAL i <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 - A114NDLG UNITS - N.P. <br />REFRIGERATION UNITS -H P. EA. <br />BATHTUB <br />LAW.TORY ( WASH BASIN, <br />BOILERS - B T.U./1/ P. <br />SHOWER <br />GAS FIRED A.C. UNITS - B.T.U. <br />KITCHEN SINK 6 DISP <br />FORCED AIR SYSTEMS - B.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 />EVAPORATIV; COOLERS <br />_ <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGEHOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR, ETC.) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />' <br />HEATPUMP <br />GAS PIPING <br />I <br />EKHAUSTFAN <br />I <br />SUB TOTAL f <br />SUB TOTAL <br />' <br />PERMIT S <br />PERMIT <br />' I' <br />TOTALFEE S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. �. i <br />I <br />REAR SE BACK <br />SIDE SET ACK <br />PUNT 5ETBACK <br />I-o <br />N1�- <br />I <br />U ZE <br />UN <br />LOT AREA <br />VACANT SIZE <br />FEES <br />VALUATION <br />FEE' <br />C' <br />DYES ONO <br />BUILDING <br />S <br />L I <br />TYPE OF CONS( <br />OCCUPA14CY GROUP <br />NO. <br />OF DWELLING UNITS <br />PLUMBING <br />SIZE OF MOO <br />NO GF SIORIEA <br />MAX OCC. LOAD <br />MECHANICAL <br />- <br />I I" <br />I' <br />OTHER <br />STATE BUILDING SURCHARGE <br />I• <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE ENERGY SURCHARGE <br />APPUCAIIONACC BY <br />PLAITS C14ECKED BY <br />APPR. FORISSUANCE BY <br />PUBLICWORKS <br />TOTAL <br />Nam//`(IV//� <br />♦V//�/ <br />I <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />I <br />