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APPLICATION FOi -' <br />IRA ErBIpAN,n CITY OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />269.8746 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ZSIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Zt-r G 11-1FA+MC-1 /S,L gaoTGes WAV 48dOa. <br />ARCHITECT OR DESIGNER MAIL AD.'IRESS CITY ZIP PHONE <br />.9emERRt CONTRACIOR MAIL ADDRESS L C 11Y 5 C iaTTL EZI P PHONE LICENSE <br />Y KFgof- �iIL:N (A_L1LL•, i►l�,LMIwtD2AyLNb, 40109 (aP�tl�4a43ME��.PL2�R! <br />MECHANICAL CONTRACTOR WAIL ADDRESS CITY ZIP PHONE LCENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />110 NEWS ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.IN SEAT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOSI or MATSRMLS PLUS LABORI <br />DESCRIBE WORK <br />IIVSTdL_L. 1 MC:-r) _i Tt.Lt IAAG ..Yn.,u IL.I <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LEGAL DESCRIPTION OF PROPFRTYISHOWN BELOW OR ATTACH FOUR COPI_SI <br />LOT_BLOCK __0 <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA 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 CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PROJECT ADDRESS} a0 � <br />APPLICANT CITY BUSINESS LICENSE NO. 3 3y `l <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P. EA, <br />LAVATORY WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK B 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 />_ <br />_ <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-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL B <br />PERMIT 7 <br />PERMIT S� <br />TOTAL FEE f <br />_ _ <br />TOTAL FEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />P K REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER <br />FEE <br />LOTAREA VACANT SITE <br />OYES ONO FEES VALUATION <br />NST. OCCUPANCY GROUP NO. OF DWELLING UNITS <br />BUILDING S <br />SIZE OF BLDG <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />HECK <br />//J�� <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />PLAN <br />RECEIPT NO. <br />FEE <br />