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I <br />R,EY,Fo..R APPLICATION �rOR everetl <br />cln of <br />CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING 0 SIGN 't <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />SIL,n Sit S.c. E A VJ <br />ARCHITECT OR DESIGNER MAIL ADDRESS LITY ZIP PHONE <br />1 <br />PLUMBING CONTRACTOR MAILADPRESS CITY ZIP PHONE LICENSE• <br />1�1 ucw ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />p <br />(D <br />0 <br />0 <br />r,l— L__� . cI/_ , I�..I L1IM Z:3- ,F =0 Tr 'T-�o Chi n A I � C. r_T--�1 6 <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW TH E SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />LFGAL DESCRIPTION OF PROPERnISHOWN BELOWORATTACH FOURCOPIESI <br />OF'YVORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK 0 <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 />SIGNATURE OF.7ONfRACTOR OR AUTHORIZED AQFNT DATE <br />X — & a3 8 LF <br />F <br />y <br />_ <br />_ <br />PROJECTAODRESS <br />APPLICANTSCITIrBUSINESS LICENSE NO. <br />SII S.E. CyR;Mal J_ l�j <br />3zo <br />r- _ <br />PLUMBING:__ <br />MECHANICAL <br />NO. <br />OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_TYPE <br />W'ATER CLOSET(TOILET) <br />AIR COND. UNITS—H. P. EA. <br />_ <br />BATHTUR <br />REFRIGERATION UNITS—H. P. EA <br />_ <br />LAVATOPY(WASH SAS_I NI <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />_ <br />KITCHEN SINK n UISP. <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 />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— GEM. <br />_ <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK ISERVICE—CAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />___ <br />TOTALFEE sl <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUUBER—PLAN CHECK N <br />FEE <br />FEE RECEIPT O <br />LOT AREA VACANT SITE <br />FEES VALUATION FEE <br />DYES ONO <br />.xnia.wr•v rnnua NO. OF DWELLING UNITS <br />OF STORIES I MAX. OCC. LOAD <br />ACC. BY PLANS CHECKED BY I APPR. FOR ISSUANCE BY <br />BUILDING <br />S(Z oso CX) <br />J <br />00 <br />0 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />J <br />TOTAL <br />� 1 <br />__\\ <br />(9v <br />i <br />ml,_ <br />