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EOf mD CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEN ] /� MAIL ,7DRESS CITY 21P PHONE <br />ARCHITECT rlrl,5 tsw�r-La Cob/NER en / AIL DRESS 16 / L 2-1nli r DITY L v, ruff" TIP y 01 PHF,N 15 a - 617 � — <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSF <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 />❑ NEW M AUUI ION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VAT UANnN nr Wnnn Irn51 nr Mnn nml S PL US I ABnm -- <br />Of SCRIBE WORK 1 1 1 <br />L71 . 1 I A G <br />USF OF BUILDING <br />or <br />OY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />AND KNOW THE SAME TO BE TRUCAND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF 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 />X 6-+ , <br />NO O LEGAL DESCRIPFPRO TY ISHOWP BELOW OR ATTACH FOUR COPIES) <br />����/T <br />LO)I DIBLOCI�OF_ <br />QQ. T _ <br />3c ; <br />PROJECT ADDRESS <br />Iglu ll <br />APPLICANTS CITY BUSINESS 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 ITOILETI _ <br />COND. UNITS-H.P. EA. <br />BATHTUB <br />_AIR <br />REFRIGERATION UNITS—H. P. EA. <br />LAVATORY )WASH BASIN) <br />BOILERS EA. <br />.Iy <br />�— <br />SHOWER <br />GAS FIREDD AC AC. UNITS —TONNAGE EA. <br />KITCHEN SINK A DISP. <br />_ <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 />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C. F.M, <br />_ <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— IAINLEADERS <br />METAL FIREPLACE X CHIMNEY <br />. <br />SINK(SERVICE—BAP. ETC) <br />WOODSTOVE/FIREPLACE INSERT <br />_ <br />SUB TOTAL <br />SUB TOTAL f <br />_ <br />PERMIT f <br />PERMIT f <br />__ <br />TOTAL FEE 3 <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I RUNT SETBACK <br />IILAR SETBACK <br />SIDE SETB�K <br />S <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />2—� <br />LOT AREA <br />I)L;O ���• <br />VACANT SITE <br />OYES S),F10 <br />FEES <br />VALUATION <br />TEE <br />TYPL OF `OONSI <br />`- <br />OCCUPANCY GROUP <br />IZC —? <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />Slll Ill I CU <br />Sr <br />NO UI SI(IRIES <br />I <br />MAK OCC. LOAD <br />•� <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ' NO <br />MEC14ANICAL <br />OTHER <br />-- <br />PENALTY <br />APPI )CATION ACC By <br />I`LAHS CHUCKED BY <br />APPR FOR ISSUANCE BY <br />TOTAL <br />—_ <br />