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FME„�»R kOPLICATION FO <br />CM OF CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />1; 259•8745 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />± OWNER '/ MAIL ADDRESS LIfV ZIP PHONE <br />❑ SIGN <br />! AMGMITEGTOR DESIGI��' <br />I <br />MAIL ADDRESS <br />CI1V <br />21P <br />PNr•!E <br />1 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOR <br />1 <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />LICENSE A <br />• PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PIIONE <br />LICENSE• <br />j CLASSOFWORK <br />❑ NEW ❑ ADDITION <br />I ALTERATION ❑ REPAIR <br />❑ DEMOLITION ElWOOOSTOVE/FRPL.INSERT <br />❑ <br />BUILOING RELOCATION <br />VALUATION 7 WOy�RK(COST OF MATERIALS PLUS LABORI <br />I DESCRIBE <br />USE OF BUT DINOT <br />1 HEREBY CERTIFY THAT I HAVE READ AP- D 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 OF' <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION orPROPERTYISHOWNBELOW ORARACHFOUR COPIESI <br />LOT__BI.ocK_or <br />PROJECT ADDRESS <br />Avo y <br />APPLICAN TS CITY B SINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET)_ <br />AIR COND. UNITS —HP. EA. <br />REFRIGERATION UNITS—H.P. EA. <br />BATHTUB <br />LF,VATORY(WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS—IONNAGE EA <br />KITCHEN SINK DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.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 />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE IIOOD <br />FLOOR DRAIN <br />Q(� <br />AIR HANDLING UNIT— <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />_ <br />METAL FIREPLACE A CHIMNEY__ <br />SINK SERVICE —BAR, ETC) <br />WOODSTOVE/FIREPLACF INSE`li <br />_ <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT 1 <br />_ <br />PERMIT IT <br />_ <br />TOTALFEE S <br />TOTAL FEE 8 <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SF'BACK <br />-- <br />REAR SETBACK <br />N.A• -- <br />SIDE SETBACK <br />PLAN CHECK NUMGER <br />Q� <br />--=��- <br />PLAN <br />FE// 3� — <br />CHECKrEE -- <br />RECEJQTjJ0.26 <br />USE ZONE <br />- <br />Z <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />_ <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />OUILOING <br />El its <br />V <br />SIZE OF BlDO <br />NO. OF STORIES <br />MAX.000.1OAO <br />PLUMBIIIG <br />00 <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />— <br />0711ER <br />PENALTY <br />APPLILAIION ACC DY <br />PLAN$LHECKED BY <br />APPR fOR I$$UANC[pY <br />TOTAL <br />_ <br />