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E rynAn APPLICATION FGR <br />tftCONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER 1 MAIL ADDRESS, j /(. I.`l �• 1OLFJLY.fj/.l ZIP PRONE <br />w ( IL' `r ,47 iy�' I A I" YID/l)l <br />ANCIITICI OR DESIGNER MAIL ADDRESS CITY ZIV IIIIVNt <br />r.ruFnM rnNIRArT0P MAIL ADDRESS CITY ZIP PIIONF LICENSL <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />Of MATE RIAI5 <br />REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />DESCR/�IDE WORK ) <br />/mac <br />USE OF BWLDIND <br />I <br />% <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 />PLICATION <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED 1IERE- <br />IN ORNOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACT RAUUTH RIZZEEDDQ�G ENT DATE--/,�/.f <br />i/ <br />aL, r( ( I� V V <br />LLGAL III 6CRIPRON OI PDOPLRI Y raP rev DI.1 OW On ATTACT I oun coPlrs <br />) / / <br />LOT�BLOCIFwG or /<./"�� "� <br />/KA �4T 6T .A (��IL. _.`L7 C—�QoLI LN <br />PROJECT ADDRESS <br />Y� �� .5 i <br />APPLIOAN S CRY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA, <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS—IONNAGE EA <br />KITCHEN SINK 8 DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—BT.U. M <br />CLOTHES WASHER <br />_ <br />_ <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <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 />STOVE _ <br />_ <br />ROOF DRAINS—RAINLEAOERS <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />SINK SERVICE —BAR ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL f <br />PERMIT S <br />PERMIT f <br />_ <br />TOTALFEE f <br />TOTALFEE s <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I PONT SETBACK <br />::�;] <br />RLAR S,LL I BACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />[/ / <br />RAN <br />.33 <br />CHECK FEE •yC] <br />USE IONF <br />R_Z <br />LOT All A <br />/ A <br />VACANT 511E <br />OYES *0 <br />FEES <br />VALUATION <br />FEE <br />IYFIE OF C0N%T <br />-Al <br />OCCUPANCY GROUP <br />R-3 <br />NO. OF DWELLING UNITS <br />� <br />BUILDING <br />s <br />SIZE OF RLOG <br />CG/• <br />/3/0d <br />NO OF STORIES <br />Z <br />MAX, OCC LOAD <br />111 <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED O YES III NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC BY <br />�Lg. <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />TOTAL <br />