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PPLICATION FOK <br />�°"" r CONSTRUCTION e <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL 0 PLUMBING ❑ SIGN <br />owNln u+l\ADDRESS cm ZIP MORE <br />O'GaEEwLAgB� OwL.a2 4wobaz MD EA92WAtL Wsy evcsor 9BZo[ 3Sa-7113a <br />ANCIIR[GE Oq pI.SIDNF IT MAI\ADDPf SS Clry )iP PHONE <br />PLUMBING CONIXACIOR MAN AGGRESS CITY ZIP PNONL LKENSE• <br />ff NEW ❑ ADDITION ❑ ALTERATION Cl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALU.NON OI WORA ICO9 Or "All PR�IALS PLUS IABORI <br />zk �C .cNf1JY S- <br />/_.� 1R iiuAr /_\P-F- ( I-lL_m Q- KA. l <br />U�s�tLLo_�BmL D�Nc <br />,L„yR1G2'T'r114�.7r9 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONTRACTOR OR AUTHORIIEO GENT DAIS <br />x / <br />Lfr.ALDFSCRIPUONOFFROPERIYISHOWNBELOWOR"I.c.FOURGOPIE.1 <br />1��t0 I NN-L.S 'pLJ. IJo <br />I ol_ BLOC. --or <br />- <br />^y <br />B `• 1 <br />PRf)N.l ADBRISS / / <br />F5 !-7 // /�4MWA t_ <br />APPLICANTSCHYBUSINE SLICENSL NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUAE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND UNITS-H P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />LAVATORY IWASH BASIN) <br />co <br />BOILERS-H. P. EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />_ <br />K ITC14EN SIN K A DISP <br />(0 <br />[0 <br />_ <br />FORCED A)R SYSTEMS-B T.0 MEA. <br />_ <br />DISHWASHER <br />WALL HEALERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B I.0 M <br />CLOTHES WAS <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />co <br />URINAL <br />1 <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CF.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 />SUBTOTAL <br />t <br />MIT, <br />/Sb <br />Oo <br />PERMIT t <br />PERMIT t <br />TOTAL FEE t <br />_�1—� <br />-/� <br />TOTAL FEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />3a r <br />2©r•-r <br />s r <br />s t <br />FUN, <br />—Z <br />LOT AREA <br />YACANI snL <br />.;YES ONO <br />Or CON�ST/ <br />FEE <br />OCCUPANCY GROUP <br />I <br />NO OF DftLLING UNITS <br />is <br />BUILDING <br />OI 111 PU <br />/1 IN <br />NO OI STORIES <br />MAL OGG LOAD <br />PLUMBING <br />E SPRINKLERS REOUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />ICALONACC BY <br />eIF6 <br />PLANS CHECYLD.1 <br />Je!rF <br />APP. iOq 63UAHCC BY <br />G _c <br />TOTAL <br />?7 iya-w � <br />FEU VALUATION <br />