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S`ii.PPLICATION FOl' �A� <br />FIMEWIpRTNNT <br />aw OF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION P COMBINATION ❑ BUILDING ❑ MECHANICAL <br />U PLUMBING <br />PNL <br />❑ SIGN <br />MCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />]IP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />6.OJa1` <br />Q. <br />9«lo4b <br />7-�50454 <br />cR�4-334N <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />I (3 NEW Cl ADDITION ❑ ALTERA71ON ❑ REPAIR ❑ DEMOLITION ❑ WOOUSTOVE/FRPLANSER7 ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />-2�fA L[ T cS Lam] :2,/ram Gz_\«�, ] AT A, u L-3 ., T._\1r C <br />UBE 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 OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK OF <br />PR�CT REBB <br />o LAI� <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FPITUIIE <br />_ <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.P, EA. <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H, P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />I <br />LAUNDRYTRAY _ <br />UNIT HEATERS-B. T.U, <br />CLOTHES WASHER <br />_M <br />I EVAPORATIVE COOLERS <br />_ <br />WATER HEATER Ya•- <br />CLOTHES DRYERS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />_ <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT - C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACFA _ "NEY <br />SINK SERVICE -BAR ETC. <br />WOODSTOVE/FIREPEACL INSERT <br />SUB TOTAL <br />SUBTOTAL f <br />_ <br />PERMIT f <br />_ <br />PERMIT f <br />TOTALFEE ! <br />TOTALFEF. f <br />THIS PORTION TO BE COMPLETED <br />BY BUILDING <br />DEPT. <br />PERSONNEL <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBI'1 <br />PLAN CHECK FEE <br />It[b1*001 <br />TYPE OF CONSE <br />i <br />I <br />FIRE SPRINKLER: <br />i <br />I APPUCgION ACC. BY <br />1 <br />1 <br />FEE RECEIPT NO <br />LOT AREA VACANT SITE <br />OYES ONO FEES VALUATION FEE <br />OCCUPANCY GROUP NO, OF DWELLING UNITS <br />BUILDING S <br />NO. OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />RED D YES O NO _ <br />OTHER <br />_ PENALTY — <br />PLANS CHECKED BY AMER FOR ISSUANCE DY <br />TOTAL <br />