Laserfiche WebLink
1 <br />Warr OF. <br />M:everett <br />BUILDING DEPARTMENT <br />259-8810 <br />VLICATION FO <br />CONSTRUCTION, <br />PERMIT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />evereR <br />e <br />❑ DEMOL. i ION COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN MAIL ADDRESS Cttt LP PHONE <br />nenLy 191t' 3�( 7 3e z go3 s y�'8a/ 3 <br />MAIL ADDRESS c nP PHONE <br />7pz <br />ADDRESS <br />OItY ZIP PHAONE LSENsa <br />_. .._..._ �............... MAIL <br />0L <br />CLASS OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION C REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK (COST OF AuiERIALS PLUS LABOPo <br />DESCRIBE WORK 4 •� <br />V AniO <br />USE OF BUILDING QQ <br />I HEREBY CERTIFY 'HAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNLJW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />IN <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUC LION. <br />SIGNATU OF�CTOR OR AUTHORIZED AGENT DATE <br />X e4 e <br />LEGAL or' BORIPTION or PROPERTY ISNOWN BELOW OR ATTACH FOUR COPILSI <br />of L-�"J <br />PROJECT ADDRESS <br />APPLICANrS City BUSINESS LICE14SE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />'Z <br />SET (TOILET) <br />ff <br />A/C-A/HNOLG UNITS - H P <br />REFRIGERATION UNITS - HP EA. <br />LAVATORY BASIN) <br />BOILERS - B.TU/HP <br />1 <br />MLAUNDRYTRAY <br />GAS FIRED A C. UNITS - B.T.U. <br />INK & DISP. <br />— <br />FORCED AIR SYSTEMS - B T.U. M EA. <br />ER <br />WALL HEATERS - BTU. M <br />RAY <br />UNIT HEATERS-B.T U. M <br />ASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />DRINKING FOUNTAIN <br />CLOTHES LAYERS <br />VENTILATION FAN <br />G <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAF ETC ) <br />METAL A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUS TOTAL <br />S <br />SUBTOTAL <br />'- <br />PERMIT <br />S <br />_ <br />PERMIT <br />TOTALFEE <br />S <br />TOTALFEE <br />.._ <br />RECEIPT NO. <br />PLAN CHECK NUMBER <br />pp <br />$U <br />FEES <br />T@A l <br />EFRONTSEIOACK <br />20/ <br />REAR SETBACK <br />SIDE SETBACK <br />Ll <br />USE ZONE <br />LOT AREA <br />-7 pC7 <br />I <br />VACANT SITE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />o�/`y�/'� <br />55d <br />L <br />TYPE OF CONST <br />AN <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BIDG <br />NO OF STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED O YES ❑ NO <br />STATE BUILDING SURCHARGE <br />Q <br />5 <br />STATE ENERGY SURCHARGE <br />APPOCATIONACC BY <br />III, VA <br />IVY/ r <br />PLANSCNECKEDBY <br />APPR FOR ISSUANCE BY <br />� <br />PUBLICIVORKS <br />TOTAL <br />PROPE• .. _-. _ _ <br />PROPERTY LINE LOCATIONS AND RELAfED EASEMENTS. <br />