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ArPLICATION FOR <br />E <br />E«� <br />CONSTRUCTION <br />CRYeverett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259.8810 <br />❑MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />O DEMOLITION ❑ <br />COMBINATION ❑ BUILDING <br />ZIP <br />PHONE <br />clly <br />MAIL ADORE!! <br />OWNER <br />7 <br />_ LI ZIP <br />PHONE <br />APCNITELI OR DFSI NER <br />MAIL ADD E 9 <br />uCENSE <br />clTv tIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS i AT <br />LICE N![ <br />' •.I <br />T �' i <br />' 'R CITY IIP <br />MAR ADDRESSEA <br />PMDIIE <br />Z <br />_ <br />MEGNANIU CONTRACTOR <br />(ONE <br />uCENSE . <br />LILY TIP <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />WOPk <br />❑ ❑ WOODSTOVE/FRPL.INSERT <br />BUILDING <br />RELOCATION <br />CLASS Of <br />0 ADDITION <br />13 ALTERATION ❑ REPAIR DEMOLITION <br />NEW <br />VALUAt NIN OE WOPk ILOSI 01 M AICROLlPW9LAPORI <br />. <br />DESCRIBE WORK . _ -- <br />r <br />I' I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS AI <br />USE OF BUILDING PLICAT ION AND KNOW TH E SAME TO SE TRUE AND CORRECT. ALL <br />1 rr ,.l.. - <br />LEOAL DENS OF LAWS AN <br />lCAIPl10N OF PROPVERNING THIS TYPE BELOW OR ATTNS OF LAI <br />ACH FOUR COPIESI OFFIR WORKOWIL WILLS <br />BE COMPLETED WITH WHETID ORDINANCES GHOER SPEC F ED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOI—BLOCK—DF _ GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />"ATEORL AL LAW ANYOTHERa <br />OR THE PERFORMANCE F CONSTRUCTION. GCONSTRUCTION <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />PLUMBING " <br />Orcomb <br />OF SLDG <br />S <br />(WASH BA; <br />INK S LISP <br />ACC D. <br />1-h <br />— BAR. ETC 1 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />EM <br />NC — AMNOl6 UNITS — N.P. <br />REFRIGERATION UNITS — H.P. EA <br />BOILERS — B.T.U.M.P. <br />GAS FIRED A.C. UNITS —B.T.U. <br />FORCED AIR SYSTEMS —S.T U. M <br />WALL HEATERS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />G EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACEINSERT <br />NEAT PUMP <br />GAS PIFIN 3 <br />EXHAUST FAN <br />SUB TOTAL <br />SUB TOTAL <br />S <br />PEROT <br />PERMIT <br />S <br />TOTAL RE <br />TOTALFEE <br />S <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />VALUATION FEE <br />FEES <br />I OT AREA <br />VACANT SITE <br />S <br />DYES ONO <br />BUILDING <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />-- <br />PLUMBING <br />No OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />IRFD ❑ YES D NO <br />STATE ENERGY SURCHARGE <br />PLgNS CHECKED BY <br />APER FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />WNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />ONE ANO RELATED EASEMENTS <br />PPROPERTY ROPERTY ONS <br />LOCATIONS <br />