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D <br />,E„, w ,fAPPLICATION FeR <br />DI^°` CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCAIION <br />VALOAbON Or WORKICOST Or MATERIALS PLUS LABOR, <br />DES BE WORK <br />USE OF BL'RDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNONTHE SAME TO BE TRUE ANDCORRECT.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 GP IINTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REG U LATI NG CONSTRUCTI ON <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATUREOF CONTRACTOR OR AUTHORIZED AGENT GATE <br />X <br />LEGAL DESCRIPTION OF PROPERTYHOWNB-LOWOR ATIACH FOURCOPIES' <br />Lor BLocK—oF <br />PROJECT ADDRESS <br />T'1 co <br />APPLICANTS Cl" BUSINESS LICE NSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />AIC — AIHNDLG UNITS — H P <br />BATHTUB <br />REFRIGERATION UNITS —H P EA <br />LAVATORY I WASH BASIN) <br />BOILERS — B.T U H P <br />SHOWER <br />GAS FIRED AC UNITS — BTU. <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS — B T U M EA. <br />DISHWASHER <br />WALL HEATERS — B T U. M <br />LAUNDRY TRAY <br />UNIT HEATERS — B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL <br />f <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTALFEE <br />f <br />TOTAL FEE <br />r PONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCH �CK/NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />ES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />S <br />TYPE ONSL <br />�Ad <br />0 CC PANC GR .QP ¢ <br />A./ 6� <br />NO OF DWELLING UNITS <br />-&— <br />PLUMBING <br />SIZE Or BLOC NO OF STO IE <br />3�,� 0! <br />FIRE SPRINKLERS REQUIRED VES Cl NO. <br />MAX OCC LOAD <br />�/ <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />L <br />� � <br />STATE ENERGY SURCHARGE <br />P, 1, AF, "I A IT, <br />PLANS CHECKED W, <br />APPR rOR IC5uAN0E Dv <br />J <br />PUBLIC WORKS <br />TOTAL <br />l% <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />