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Ift 'APPLICATION FO <br />on OF <br />CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />i BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />❑ SIGN <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW ❑ ADDITION .ICI ALTERATION ❑ REPAIR Cl DEMOLITION Cl WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />■ <br />USE OF BUILDING <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 />PROVISIONS OF 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 Ole <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE CF CONTRACTOR OR AUYHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_BLOCK-._Or <br />PROJECT ADDRESS <br />. a <br />APPLICANTS Cl FY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />_ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER 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 A.C. UNITS -TONNAGE EA <br />KITCHEN SINKS DISP. _ <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />_ <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOWASHER <br />_ <br />_ <br />EVAPORATIVE COOLERS <br />EATHES <br />WATER HTER <br />_ <br />CLOTHES DRYERS <br />_ <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING 2UNTAIN <br />RANGE HOOD <br />FLOOR DRAII, <br />AIR HANDLING UNIT- C.F.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 />_ <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT t <br />PERMIT S <br />TOTAL FEE $ <br />TOTALFEE S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />Nry ' - <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />8�/�6 / 3 <br />.LAN <br />E <br />CHECK FEE <br />RECEIPT NO <br />USE LONE <br />LOT AREA <br />- <br />VACANT SIIE <br />OYES J?NOIVA <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST, <br />OCCUPA/C�FCYGIROUP <br />J ` <br />NO. OF DWELLING UNITS <br />D <br />BUILDING <br />i <br />SIZE OF SLOG. <br />M, A <br />NO. OF STORIES <br />3 <br />MAK OCAC �LOAAD <br />/Y , J • <br />PLUMBING <br />-_ -_ <br />- <br />FIRE SPRINKLERS REQUIRED NYES ❑ NO <br />MECHANICAL <br />-- <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />PLANSCHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />