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everett <br />BUILDING DEPARTMENT <br />259•8745 <br />'PLICATION FO o <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING [g•MECHANICAL <br />.uu •nnoFAR CITY I ZIP <br />A <br />M-PLUMBING <br />PHONE <br />PHONE I <br />PHONE <br />••1 1 <br />EYEFER !`A <br />e� <br />i <br />s <br />❑ SIGN <br />1. <br />MECIYAICALCONTAACTOR MAIL AVORE35 <br />1 <br />ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADORE09 CITY • 1 <br />I' <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION (� AL"SRATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION i <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />DESCAISE WORK - I • ni 11T. r/� . I I r �/) Tr // `L-� \ l <br />I / I `J I / r I <br />I I _ - -- <br />all BUADINpI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIAD THIS AP• <br />IZ�S I I�1C-C <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />(op <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF PROPFRIY (SHOWN BELOW OR ATTACHFOURCOPIEA <br />L(jµpEBCRIFIgN <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOIN IIKOCKOF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />GIVE <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 (pf) - c 0e cy h5v <br />APPLICANTS <br />CITY BUSINESS LIGEN5E NO. <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUM NO <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />AIR COND. UNITS—H.P. EA. <br />CLOSET TOILE <br />WATERREFRIGERATION <br />UNITS—H.P. EA. <br />_ <br />BATHTUB <br />BOILERS—H.P. EA. <br />LAVATORY WASH BASIN) <br />GAS FIRED AC, UNITS —TONNAGE EA <br />' SHOWER <br />FORCED AIR SYSTEMS—S.T. U. M EA. <br />KITCHEN SINKt DISP. <br />WALL HEATERS—B.T.U. M <br />DISHWASHER <br />UNIT HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />' URINAL <br />RANGE 400D <br />' DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE 6 CHIMNEY <br />ROOF DRAINS-RAINLEADER9 <br />WOODSTOVE/FIREPLACE INSERT <br />SINK SERVICE -BAR ETC. <br />QO <br />SUB TOTAL t <br />SUBTOTAL <br />' <br />PERMIT t <br />• <br />PERMIT t <br />TOTALFEE t <br />TOTALFEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />910E SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />OVER ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE Of CONST. <br />OCCUPANCY GROUP <br />NO. OF OWELLINO UNITS <br />BUILDING <br />S <br />BIZE OF SLOG <br />NO OF STORIES <br />MAX OCC, LOAD <br />PLUMBING <br />FIRE SPRINKLERS AEGUIRED ❑ YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />AP/LIGATION ACC. BY <br />PUNS CHECKED BY <br />APPP. FOR ISSUANCE BY <br />TOTAL <br />