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APPLICATION F06L <br />the CONSTRUCTION <br />everett PERMIT e <br />10 BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION El BUILDING ❑ MECHA►'ICAL�_ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS Cln PP PHONE <br />T��, f;ra�L a�OL� C��t�.��C3zvc.��FE7� 9�a�� �5—c���� <br />ARCHITECT OP. DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GrENERA[ CONiRAC10R// <br />MAIL ADDRESS <br />�" <br />CIn ZIP <br />�/I}Q)lL!—� <br />PIIOTLE LICENSER <br />'�l <br />���� <br />)l(0,'wf��,L4', <br />�y�%� v�;.J-D.��O�%/� <br />•\ET�w Er.-Q .��Il_i_v_JGw <br />Ji <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CIn ZIP <br />PHONE LICE[ E R <br />PLUMBING CONTRACTOR <br />[MIL ADDRESS <br />CITY 71P <br />PHONE LICENSER <br />❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION Or WORK (COST 01 MATERIAL S PLUS LARORI <br />A h iT /) i) <br />OEBC"E WOnK I / <br />USE Of BUILD[ <br />I HEREBY CERTIFY T.'AT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TIWE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITF, WHETHER SPECIFIED HERE- <br />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 CR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR On AUTHORIZED AGENT DAZE <br />LEOALDESCRmLONO, PROPERTY (SHOWN BE LOW on AT TACH roun COPIES[ <br />LOTBLOCKOFIN <br />PROJECT ADDRESS <br />PLUMNINO <br />A '_ICANTS CITY BUSINESS LICENSE NO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_ _ <br />FEE_ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE_ <br />WATER CLOSET (TOILE <br />_ <br />AIR COND. UNITS —HP. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />_ <br />LAVATORY (WASH BASIN) <br />801LERS—H. P. EA. <br />SHOWER <br />GAS FIRED A . UNITS —TONNAGE EA. <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-0 T.U. _ M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />_ <br />FIANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—NAINLEADERS <br />METAL FIgEPLAGEBCH[MNEY <br />_ <br />_ <br />SINK SERVICE —BAR, ETC.[ <br />VuJDSTOVE/FIREPLACE INSERT' <br />SUBTOTAL <br />SUBTOTAL S <br />_ <br />PERMIT $ <br />PERMIT f <br />_ <br />_ <br />TOTAL FEE ! <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECGIPt NO. <br />LOT AREA VACANT SITE <br />FEES VALUAtION FEE <br />DYES ONO <br />OCCUPANCY GROUP <br />NO. OF DWELLINEI UNITS <br />BUILDING <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMB114G <br />RED ❑ YES ❑ NO <br />MECHANICAL <br />Oi11Eq <br />PENALTY <br />PLANSC14ECKED 81' <br />APPR FOn ISSUAII^F DY <br />— <br />TOTAL <br />S <br />