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APPLICATION FOk'-"' <br />M. Enrgmn <br />CRY OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER <br />M,dl ADDRESS lry ZIP PHONE <br />D�1 �i[CC-SS <br />�6 Fi�lz�-�t Jwy 'li�EiT <br />ARCHITECT OR DESIGNER <br />M IL ADDRESS CITY ZIP PHONE <br />CITY <br />C-arzRAl Al6vi luc. to, P" 52b9 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />/-V"gpD <br />CITY <br />n0lfb 776-8835" ,�caewf <br />ZIP PHONE <br />LICENSE • <br />,t�'1?E <br />LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PIIONE <br />LIGFNSEA <br />LUA;NEW ❑ ADDITION El ALTERATION ❑ REPAIR ❑ DEMOLITION ElWOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />OF WORKICOSI-QF MATERIALS PLUS LABOR, <br />l b5)YHbL r) ) SSG , i J J, ... At A4F11f < ' . J A, e w, A.E. A.. . -P.- <br />. <br />USE OF BUILDING <br />�Ai1nh7517-clIft <br />I HEREBY CERTIFY TI4AT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTYBIlOWN BELOW OR ATTACH FOUR COPIES, <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING T4ISTYPE <br />LOT— BLOCK _0 <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 />SIGNATU F CONTRACTOR OR AUTHORIZED AGENT DATE <br />X 0I <br />PROJECT <br />ADDRESS <br />APPIICAN :CITY BUSINESS LICENSE NO. <br />3b5 16, E1`616'r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUREMFEENO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET)AIR <br />COND. UNITS-H.P. EA. <br />BATHTUBREFRIGERATION <br />UNITS—H.P. EA.LAVATORY(WASH <br />BASIN)BOILERS—HEA.SHOWER <br />GAS FIRED 0.C.UNITS—TONNAGE EAKITCHEN <br />SINK d DISP.FORCED <br />AIR SYSTEMS—B.T.U. MEA. <br />DISHWASHERWALL <br />HEATERS—B.T.U.M <br />LAUNDRYTRAYUNIT <br />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 UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAINLE <br />METAL FIREPLACE& CHIMNEY <br />SINK (SERVICE —BAR, ETC) <br />) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE RECEIPT NO. <br />US1 <br />Li��OTAREA <br />VACANT <br />N0 <br />OYES ONO <br />FEES <br />__ <br />VALUATION <br />FEE <br />ttPE OF CONST. <br />OCCUPANCY GROUP <br />I NO OF DWELLING UNITS <br />OF BlDO, <br />NU OF StORIF$ <br />MAX OCG LOAD <br />BUILDING S <br />PLUMBING <br />SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />,CATION ACC. BY <br />PLANS CHECKED BY <br />�� <br />APPR. FOR ISSUANCE By <br />4TOTAL <br />