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c. <br />;,,. PPLICATION FO <br />G E <br />CONSTRUCTION <br />everett <br />PERMIT <br />` BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />evereR <br />e <br />❑ SIGN <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CIry ZIP PHONE LICENSE <br />:LASS OF WORK <br />❑ NEW ❑ ADDITION a ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOD STOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />/ALLATION OF WORK ICOST OF MATERIALS PLUS LABOR[ <br />LOT_ <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 LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA 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 OR <br />PROJECT ADDRESS/? <br />APPLI NT'B cirf BUSINESS LI NSF 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 [TOILET) <br />A/C — A.HNDLG UNITS — H P. <br />BATHTUB <br />REFRIGERATION UNITS — H.P. EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.U./H P. <br />SHOWER <br />3AS FIRED ABC. UNITS — 8.T.U. <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS — B T U 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 />_ <br />SACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC.) <br />METAL FIREPLACE a CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SU2 TOTAL <br />bUll TOTAL <br />PERMIT <br />t <br />PERMIT <br />TOTALFEE <br />t <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />-- - - <br />LOT AREA <br />VACANT SITE <br />OYES OHO <br />FEES <br />VAlUA110N <br />FEE <br />BUILDING <br />S <br />- <br />TYPEOFCONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPR.NKLERS REQUIRED ❑ YES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />PLANSCHECKED BY <br />APPR FOR ISSUANCE BY <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY UWNEHS AHE HESPV INJICLC r V N UN I CNMININU nu <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />