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1 <br />APPLICATION FOB <br />Dr.OF M CONSTRUCTION <br />q'. OF <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ P!_UMBING ❑ SIGN <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />]ir PHONE <br />LICENSE E <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITIOF ALTERATION ❑ REPAIR <br />El DEMOLITION El <br />WOODS LOVE/FRPL.INSERT ❑ <br />BUILDING RELOCATION <br />VALUATION Of WORK (COST Of MALE IALS PLUS LABORI <br />ueec crvunA._,.G �/ <br />uffir-jBUR ING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 AGLNT DATE <br />�'_ <br />LEGAL DESCRIPTI i OF PROPERTYISIOWN BELOW OR At I AGI FOUR COPIES <br />LOT_Bl Or <br />PROJECT ADDRESS ��1 <br />cAr R[iLc �/ / ' ice%/� L/ <br />APPLICANTS CITY Bur ESS 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—H. P. EA, <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY WASH BASIN <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />_ <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—D.T.U. M <br />_ <br />CLOTHES WASHER <br />I <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />_ <br />FLOOR DRAIN <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 />Q <br />_ <br />WOODSTOVE/F I REPLACE INSERT <br />SUBTOTAL <br />LUB TOTAL S <br />PERMIT ! <br />PERMIT f <br />TOTAL FEE 0 <br />TOTALFEE B <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REARSETBACK SIDE SETBACK PLAN CHECK NUMBER ULAN CHECK FEF <br />FEE I RECEIPT NO. <br />USEZONE l01 AREA VACANT SIIE <br />-FEES VALUATION I FEE I <br />CONST. <br />SIZE OF BLDG. <br />ACC BY <br />OYES ONO <br />NO. OF DWELLING UNITS <br />NO. OF STORIES IMAK OCC LOAD <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />5 <br />