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,.PPLICATION FO►. <br />T EwrgFMR <br />CITY OF CONSTRUCTION <br />CI <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 ❑ COMBINATION ❑ BUILDING em MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />GENERAL CONTRACTOR MAIL ADDRECS CITY ZIP PHONE LICENSE• <br />crn1'17 e� //ALL,644/s <br />LICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VS` UATION Of WORK (COST OF MATERIALS PLUS LABOM <br />Y �t a,.C6 <br />DESCRIBE WORK <br />`-l.-/I. A/ /Aa 11,;7i3i <br />USE OT BUILDING <br />_ <br />T' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHE SAME TO BE TRUEAND CORRECT.ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X / 7 ? <br />LEGAL DESCRIPTION OF PROPERTY (BHCWNB OW OR ATTACH FOUR COPIES) <br />LOI—BLOCK OF - <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FFE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSETTOILETI <br />_ <br />AIR COND. UNITS—H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H. P. EA <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK! DISP. <br />FORCE[) AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—S.T.U. M <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS—B.T.U. M <br />- <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HODD _ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE 3 CHIMNEY <br />SINK SERVICE —BAR, ETC. <br />WOODS TOVE/FIREPLACE INSERT <br />Ll ar _ <br />— <br />L <br />SUBTOTAL <br />SUBTOTAL 3 <br />PERMIT 3 <br />PERMIT 3 <br />TOTAL FEE ! <br />70TALFEE $ <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 <br />TEE <br />CIIECK FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />3 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />MAX. OOC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES U NO <br />MECHANICAL <br />OTHER <br />_ <br />PENALTY <br />APPLICATION ACC, BY <br />PLANS CHECKED BY <br />APPR, FOR ISSUI NCE BY <br />TOTAL <br />