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OAF EwgneoA APPLICATION FOR PVP,PN <br />GIFYGF CONSTRUCTION <br />everett PERMIT: <br />BUILDING DEPARTMENT <br />7259- 745 TO BE COMPLETED IN INK- PLEASE PRINT <br />DEMOLITION L7 COMBINATION ❑ BUILDING L7 MECHANICAL C PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY 21P PHONE <br />Ida, P� 13(Lo' <br />& c-oJ F. 0. LSoK <br />21PI <br />s <br />Z `I� NLy- <br />ZIP I <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENCE. <br />—1� <br />PWMBRIG CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORN (COST OF MATERIALS PLUS LABORI <br />DESCRIBE WORK <br />USE OF BUILDING <br />S\I Y1F -r� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE i ND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <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 HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL OE nIPTION OF PnOPERTYI HOWN BELOW OR ATTACH FOUR COPIES) <br />941M A. �.�� <br />LOT- BLOCK. OF LA-r dH IA,1 <br />u <br />PR6IECT ADDRESS <br />ue t'Lj— <br />APPLICANTS CITY BUSINESS LICENSE No <br />PLUMBING <br />MECHANICAL <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WAA°R CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUb <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY ( WASH BASIN; <br />BOILERS—H.P. EA <br />SHOWER <br />GAS FIRED AO_UNITS—TONNAGE EA. <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.A.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />'/ENAILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RAIF:LEADERS <br />METAL FIREPLACE A CHIMNEY <br />— <br />SINK (SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUB TOTAL t <br />PERMIT 5 <br />PERMIT S <br />TOTAL FEE $ <br />_ <br />TOTAL FEE 3 <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 />FEE <br />CHECK FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <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 />f <br />512E OF pLDO. <br />NO OF STORIES <br />MA%OLC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATIONACC BY <br />PLANSCHECKEDBY <br />APPR. FOR ISSUANCE BV <br />TOTAL <br />