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un a~w"s <br />everett <br />IBUILDING DEPT. <br />259.8745 <br />V'PLICATION FOR e <br />vert!" <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />❑ COMBINATION 19 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />4Y n,unc <br />MKl�TAs't�wwNs- 8aae M,TI,L AAY gT l hw{cLLTP'1'I111E• WfW S-M277 <br />ARCHITECTORDESIONER MAIL ADDRESS CITY ZIP NONE <br />GENERAL CONTRACTOR - MAIL ADDRESS CITY ZIP, • �QULlN 1� •� LICENSE <br />'bl,��. s ti.P,ww- LL �( ec-Yo,B�x 7s�- r�[Ar�Ju,d1 , r. 9A.�7,0 A vwmrad;V /1E,I2/ <br />MECHANICAL CONTRACTOR{ MAIL A DRr.SS CHY _f ZIP PHONE LICENSE E <br />' PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />J9 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION <br />VALUATION OF <br />J!OFWWO`RK (COST OF MATTE IT ALS PLUS LABOR) <br />U <br />DESCRIBE WORK.,,�—� <br />An.iT)LJ /!f+ tlw 7-.TARP/ LI/Z1?I'. 4JPAtiG_ G)UlIC 'CAURI �/ 1L 4.A)C <br />❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />USE OF BUILDINO <br />Yes tbTaL <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 BECOMPLETED WITH WHETHEASPECIFIEDHERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <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 DESCll ,No PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />,�..,,�� <br />Lor._eLocK—oF�f�r A. <br />PRO CTA9DRE SS 4-908 J+TIV1C(L L"u <br />r <br />A PPL ICAN TB C I T Y BU SSL ENSENO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WA TER CLOSET(TOILET) <br />/D <br />OO <br />_AIR <br />COND. UNITS-H. P. EA, <br />BATHTUB <br />V <br />ao <br />REFRIGERATION UNITS-H.P. EA - <br />LAVATORY IWASH BASIN) <br />/9 <br />OD <br />BOILERS-H.P. EA. <br />I. <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />F <br />KITCHEN SINK I DISP. <br />C70 <br />/ <br />FORCED AIR SYS7EMS-B.T.U. M EA. <br />CID <br />/ <br />DISHWASHER <br />00 <br />WALL HEATERS-B.T.U. M <br />/ <br />LAUNDRYTRAY <br />00 <br />UNIT HEATERS-B.T.U. M <br />/ <br />CLOTHES WASHER <br />co <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />DO <br />/ <br />CLOTHES DRYERS <br />b�0 <br />URINAL <br />VENTILATION FAN <br />/2 <br />p <br />DRINKING FOUNTAIN <br />/ <br />RANGE HOOD <br />5'O <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />_ <br />METAL FIREPLACE B CHIMNEY <br />_ <br />/ <br />SINK SERVICE -BAR, ETC.1 <br />OV <br />/ <br />WOODSTOVE/FIREPLACE INSERT <br />7150 <br />SUBTOTAL <br />SUBTOTAL I <br />34 <br />';o <br />PERMIT I <br />PERMIT / <br />TOTAL FEE I <br />OD <br />TOTAL FEE / <br />5 T) <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />AONT SETBACK <br />riFes+b• <br />REAR SETBACK <br />2< <br />SIDE SETBACK <br />I 1 <br />PLAN CHECK NUMBER <br />PLAN CHECK FEE <br />FEE -4RECEIPT NO. <br />ISE ZONE <br />LOT AREA <br />A C . <br />VACANT SITE <br />&M ONO <br />FEES <br />VALUATION <br />FEE <br />INITYPE OF CONS7 <br />I OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />i <br />1—•?,1 ki•) <br />I <br />BUILDING <br />f/S'S 5/3, Z/ <br />'j •]5 <br />IZE OF BLDG <br />NO OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />4 <br />(DO R-� <br />M <br />Z 4- (SeS • <br />4- <br />cX) <br />MECHANICAL 3 v <br />'IRE SPRINKLERS REQUIRED ❑ YES 0 NO <br />OTHER <br />PENALTY <br />FPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />Jf,� <br />/ <br />li <br />TOTAL <br />A --,/AK . IA--14,Hr OG �7r2uL7u2ei AaoT <br />Tv Uzi 2S pr pr30vE 7vc <br />&ucE x4iF- j:,t2L/ATEOAJ Ar TA•<E <br />