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P-%PPLICATION FOk <br />1`"" <br />CAT'Ytt OOF CONSTRUCTION <br />F <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING `Q MECHANICAL <br />OWNMAIL ADDRESS T1;; 21I <br />�..._... ... ....._.._.. Wu AODR655 CITY ZIP <br />❑ PLUMBING <br />PHONE <br />❑ SIGN I <br />GENERAL L5,ONIRACIOR h1All ADDRESS �) CITY/ ZIP FHONE L"t.bl A <br />. � I // GI -/� .7 C!% i/ i /...n lA. ...IrnL' .:•rn ., i _. ..r ti-s� /��i/� ./A .r. % <br />MECHANIC .ONTRACTOR <br />h1All ADDRLSB <br />✓ <br />CITY <br />21P PITON[ <br />HCt NSk A <br />PLUMBINGCONTRACLOR <br />h1A11 ADDRESS <br />CITY <br />ZIP PHONE <br />IICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION <br />IXALTERATION ❑ <br />REPAIR <br />❑ DEMOIAIION ❑ <br />WOODSTOVE/FRPLANSERT ❑ <br />BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATLRIALS PI.115 I.ADORI <br />DESCRIBE WORK <br />11 <br />- <br />u E of BURDI"G <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />'� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVE RINI NG THIS TYPE <br />LEGA b SCRIPTIONOF PROPERTYISHOWN BELOW OR AT IACII FOIIRCOPIES <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMITDOES 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 />SIUNAIIIRLOFCONTHALIT RTI0DAIIIHORIZEDAGLNT DATE <br />X ( /� � - /Y � 5 <br />PROJECT ADDRESS <br />APPLICANTS CRY BUSINESS LILLNSE NO <br />I <br />/ � 9 <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 - AIHNDLG UNITS - H P <br />REFRIGERATION UNITS - HP EA. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />BOILERS - B T U ,H P <br />GAS FIRED A C. UNITS - B T.U. <br />SHOWER <br />FORCED AIR SYSTEMS - B T U. M EA. <br />KITCHEN SINK 6 DISP <br />WALL HEATERS - B T U. M <br />DISHWASHER <br />UNIT HEATERS - B T.0 M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR ORAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />/ <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK ISERVICE - BAR. ETC) <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />✓LAN L:HECK NUMBER <br />FEE <br />RECEIPT NO. <br />nIUNT SETDACK <br />REAR SETBACK <br />SIDE SETBACH <br />LISE ZONE <br />LOTARU <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />S <br />UYLS ONO <br />BUILDING <br />TYPE OF LONSt <br />OCCUPANCY CROUP <br />NO OF Dl4Fl LING WRIB <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />1AX OCC I OAD <br />MECHANICAL <br />OT14ER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />STATE ENERGY SURCHARGE <br />API'( ICATION ACC BY <br />PIANSCIMCKEDDY <br />APPH FOHISSIIANCP. BY <br />PUBLIC WOHKS <br />TOTAL <br />o ono norco MILJING ALL <br />— <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />