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IIL EYoprwn 44 P P L I CA T I O N Fa.. <br />CITY OF CONSTRUCTION PERMIT <br />n <br />everett LvJ <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />259-8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS /1 CITY ZIP PHONE <br />/_/a /&. /w 12In -, V. 4f2lI <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />D'4. .,o a 'P/ »,� - A/c'f;• "0" ck Br//.7ti 4izz7 73y-3,f 0 <br />MECHANICAL CONTRACTOR MAIL ADOR 55 CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK I> 2s''Li <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST Of MATERIALS PLUS LADORI <br />DESCRIBE <br />USE OF GUILOING <br />I HEREBY CERTIFY 1-HAT 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 />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OFF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATF. <br />X i��.Z f— <br />A_ <br />PPLI ANTS CITY BUSINESS LICENSE NO. <br />LEGAL DESCRIPTION OF PROPERTYjGHGWT: BELOW OR ATTACH FOU RCOPILSI <br />L°T_BLOCK_OF <br />PROJECT ADDRESS <br />_ /LOy C^ .la ✓.o,� <br />PLUMBING <br />NO. TYPE OF FIXTURE FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET TOILET) <br />AIR COND. UNITS--H. P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS-11. P. EA. <br />LAVATORY WASH BASIN) <br />BOILERS-H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS-B.T.U. MEAL <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />_ <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />I <br />ISTOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACES CHIMNEY <br />' <br />SINK SERVICE -BAR ETC.I <br />WOODSTOVE/FIREPLICE INSERT <br />AC - P•pA G.Fs A..'.✓JT <br />0` <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />0 <br />ot) <br />TOTAL FEE $ <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL a� <br />NT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHELK FEE <br />A, <br />, <br />FEE <br />RECEIPT NO, <br />•: T,' <br />ZONE <br />LOT AREA <br />VACANT SITE <br />_ FEES <br />VALUATION <br />❑ ES ONO <br />FEE <br />OF CONST. <br />OCCUPANCY GROUP <br />TO OF DWELLING UNItS,";.! <br />BUILDING <br />S <br />OF SLOG, <br />NO. OF STORIES <br />MAKOCC.LOAD <br />PLUMBING <br />MECHANICAL <br />(.-• <br />E SPRINKLERS REQUIRED ❑ YES LINO <br />OTHER <br />PENALTY <br />:1 < <br />CATION ACC. BY <br />PLANS CHECKED BY <br />APPR. <br />FOR ISSUANCE BY <br />-_ <br />TOTAL <br />. 1'•i <br />ai <br />