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PPLICATION FO...' <br />Its "" n"OF CONSTRUCTION e <br />:ITr OF <br />everett PERMIT <br />31JILDING DEPARTMENT <br />159.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />7 DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL Cl PLUMBING ❑ SIGN <br />WNE" MAIL ADDRESS F DI l 1 ZIP PHONE <br />IiC—r �a.v.- T1 1 1 //_•r flI gel' 1, (?CCX <br />ilzu crill! A, c iA,,;)Grj lkscc, <br />1s?ew <br />5- 66 <br />LLr'AJ/L'kz -,,,, ` t k <br />j6 <br />N//gg Al CONT/Rj, CTOR MAIL ADDRESS J <br />LI- WIJ L I )L6;C j7C,.1�/Z/ /'"/%),'L:�<L'/CLC <br />city <br />ZIP PHONE <br />�—�- �itit <br />'ECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE F <br />WMBINGCONTRACIOn <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE• <br />❑ NEW ❑ ADDITION )21 ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPLANSERT 0 BUILDING RELOCATION <br />;RISE WORK I, <br />41,],%..; — •-l' 4 -T J.•/c /., l /JT /<77A-TI% l-?/L/C/L[L J[[ <br />sE F euaolNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOWTHE SAMETOBE TRUEANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS I YPE <br />EOAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI <br />j420 &Z. <br />r_BLOCK J <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />Oi <br />IN OR NOT. TH E GRANTI NG OF A PE RM I T DO ES NOT PRE SUM E TO <br />.-- <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />_ <br />12L LA I:- .L 101z-`� <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNA RE CONTRACTOROI AUTHO ED AGENT DATE <br />X �,L <br />L �J— / <br />ROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />�L°13ClK k LI Fit <br />L e )Z <br />TLUMBING <br />_MECHANICAL <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. TYPE OFEOUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASI NI <br />BOILERS—H. P. EA. <br />_ <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE FA <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <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 />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR ORAIN <br />AIR HANDLING UNIT— C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREP..ACE A CHIMNEY <br />_ <br />SINK I SERVICE —BAR, ETC.) <br />WOODSTOVE/ 9RE PLACE INSERT <br />SUB TOTAL <br />SUBTOTAL f <br />PERMIT <br />f <br />PERMIT 3 <br />_ <br />TOTALFEE <br />3 <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />BONE SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER /1 PLAN CHECK FEE <br />AIX/./f _17 :1 FEE Lj, _ RECEIPT 110(- <br />'SL ZONE LOT AREA VACANT SITE -/ E <br />FEES VALUATION FEE <br />3 <br />/Y-/,r <br />DYES O <br />TYPE OF CON11 <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />912E Of BLDG <br />T� <br />NO OI STORIES <br />✓J <br />MAK OCC LOAD <br />1l1 ) <br />O� <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED D YES NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICA110NACC BY <br />114W\ <br />PLANSCRECKED BY <br />/nj-o— <br />APrn FOR ISSUANCE BY <br />TOTAL <br />f �ZOL� <br />