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,t,PPLICATION FOB. <br />CITEOF <br />CITY OF CONSTRUCTION <br />e•verett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION It BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAII. ADDRESS CITY :IP PHONE <br />&L6.41ataK I,IIt /YI'KICLEt61 l3Cy/) r_tirxErr 5-3 663E — <br />— <br />AR!C�INTECIURDESIGNLH MAIL AODHESS OFY ZIP PNONL <br />ITH-�. 'TA T. ✓'rR 1312.3 A'!- /LY rMJ r- i\7CZjA,11D __.. clis"-e3y 571-�:;l3 <br />oLnynAL COHiRA^^clo" <br />MAIL AnnnLSS -- - <br />city <br />rR• PHONE <br />11C.VNSE. <br />J <br />5)1+.� <br />& RS 1 C <br />E� <br />L. l Q2 DIV <br />OTT Cho /7QJA'£ClI <br />MLCNANILAI. CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />I ICE 11SE A <br />Pt UMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PRONE <br />UCLNSI- <br />SA'-Y6_ <br />3'9�• �- <br />jCLASSOF WORK <br />NEW ❑ ADDITION <br />❑ ALTERATION ❑ REPAIR <br />Cl DEMOLTION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ <br />BWI.LING RELOCATION <br />V7ATION OF WORK(COST OF MATLHIAL. PLUSlABORT <br />/7 A.i.- <br />E SCRIBL WORM <br />(1 a? <br />USE 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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR AILACH FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />LOT— BLOCK OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />/A (( f ii CN I-D <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONIRACTOR OR AUTHORIZED AGENT HATE <br />X /J <br />fsLI!!i /ZY/dC177 <br />PROTECT ADDRESS <br />APPMCAw.S CITY BUSINESS I ICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />AIC - AIHNOLG UNITS - H P <br />BATHTUB <br />REFRIGERATION UNITS - li P EA <br />LAVATORY (WASH BASIN) <br />BOILERS - B T U IH P <br />SHOWER <br />GAS FIRED A C. UNITS - B T.U. <br />KITCHEN SINK & DISP <br />FORCED AIR SYSTEMS - B T U. M EA. <br />DISHWASHER <br />WALL HEATERS -B T.0 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 />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEAOERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC I <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />NEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />S <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEE 5 <br />RECEIPT NO. <br />HEAR SETBACK <br />SIDE SETBACK <br />I IZNI SE IDAL✓� <br />YT <br />7 <br />C <br />USE LONE <br />LOT AREA <br />VACANr1 SHE <br />FEES <br />VALUATION <br />FEE <br />$ <br />17 <br />-� <br />T� <br />;IYES O <br />lJ <br />ICHIP <br />UllDING <br />TYPE 0&7T <br />OCCUPANCY GROUP <br />NO CFDWFI LING UNITS <br />`�-^� <br />_ 1114 <br />vp_ <br />PLUMBING <br />SIZE OF BI OG <br />NO OF STORIES <br />u% OCC lOAO <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES 'o0 <br />jT'� <br />STATE ENERGY SURCHARGE <br />3 <br />S <br />APPI ICATION A^CC11 <br />PLANS CHECKED BY <br />4PI'R fOD I55(IAUCL BY <br />PUBLICWORKS <br />^^BnnY <br />TOTAL <br />cTcoulAuur At I <br />PHUrtH IT uvv14mnan • _. �•�•--_. _..__.__.... <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />