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kaVI-ICATION FORS''' PYEF!„ <br />the CRY, CONSTRUCTION qT/ OF <br />everett PERMIT <br />BUILDING DEPARTMENT 259.9810 TO BE COMPLETED IN INK - PLEASE PRINT <br />n n9MOLITION ❑ COMBINATION C BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />ti <br />PLUMBING CONTRACTOR MAIL ADDRESS CRY !T PHONL LK-L"SL <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOL111ON ❑ WOODSTOVEIFRPL.INSERT ❑ BUILDING RELOCAil011— <br />VALUATION OF WORK' OSi OF MA IT RIALS PLUS LABOR, <br />f `-CC) <br />.CC) <br />DESCRIBE WORK-J <br />-f, r R <br />uu Dr ►.I DING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED <br />THIS AP. <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />SCRIPTION OF PROPERTY I5HOWN BELOW OR AT IACH FOUR COPIES' <br />LEOALO <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK- OF <br />IN OR NOT. THE GRANTING OF A PERMITDOES 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 />SIGIIAIUPE OF CONIRACTOR OR AUTHORIZED AGENT 041E <br />PROJECT ADDRESS <br />APPLCAN PS CITY BLISINE yLICENSE NO <br />PEU �Q <br />MECHANICAL <br />NO• <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NC. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />RIC — AIHNDLG UNITS — H. V. <br />REFRIGERATION UNITS —H P. EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS — B.T.U.lH P. <br />SHOWER <br />GAS FIRED A.C. UNITS —B.T,U. <br />KITCHEN SINK d OISP <br />FORCED AIR SYSTEMS — B.T U. M EA <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS — B T U. M <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />CLOTHESDRYERS <br />URINAL <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR GRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE —BAR. ETC.) <br />METAL FIREPLACE $ CHIMNEY <br />FIREPLACE'NSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />— <br />SUBTOTAL f <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />TOTAL FEE <br />REAR SETBACK <br />y\P-L(A�N�C ECCKK N'"U�MBER <br /><.J v VL�?� 1 <br />FEE <br />RECEIPT NO. <br />FEE <br />FRONT $FIDAL'K <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITL <br />FEES <br />VALUATION <br />DYES ONO <br />BUILDING <br />S� <br />TYPE OF CON91 <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX. oc0 I OF <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />STATE ENERGY SURCHARGE <br />APPLICATION BY <br />PLANS CNECKFO BY <br />APPR iORISSVANCE BY <br />ACC <br />PUBLICWORKS <br />TOTAL <br />rnvr <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />