Laserfiche WebLink
e <br />APPLICATION FOB.; evereR <br />CIFfOl"'E'" CONSTRUCTION <br />cln . <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑SIGN <br />/MAII. ADD/RESS// ,T/ rJJ ( F�CITY ZIP PHONE <br />OWNER <br />IrtD -f'T (�[ -� Z'C 4 ke ' 1%f r�) C.lrr ell 4-201 'i Y�If .32:i13 <br />MAIL omLLsb cn GIP rnouL <br />PIUMBMC CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE MAIL <br />PASS OF WORN <br />0N ❑ REPAIR ❑ DEMOLH ION ❑ WOODSTOVE/FRPL.INSERT ClBUILDING RELOCATION <br />NEW Cl ADDITION El ALTERA11 <br />TALUATIONOF WORKI7OS10F MAILRUI PLUS LABONI <br />E7EJlJ- C� <br />DESCRIBE WORK <br />USE OF ell I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AI.L <br />LEGAL DESCRIPTION OF POPERIYISIIOWN BELOW OR ATTACH FOUR COPIESI PROVISION-3 OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WI IETHER SPECIFIED HERE- <br />LOT_BLOCK—OF IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCGL THE PROVISIONS OF <br />ANY HE ER FORMASTATEOR LOCAL LAW CONSTRUCTION. <br />REGULATING CONSTRUCTION <br />OR THE PERFOfiMANCE OF CONSTRUCTION. <br />SIGNATURE OI° TRACTOR�A THORIZEDAGEHT DATE <br />l= — --.) Z_ I - <br />APPLICANf5p1�Y DUSINE55 LI'ENSE NO <br />PROJECT ADDRESS � <br />_Y <br />MECHANICAL <br />— <br />PLUMBING <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />NO. <br />WATER CLOSET ITOILE 1) <br />/y <br />r� <br />_ <br />c'z'i <br />REFRIGERATION UNITS-ILP. EA. <br />REFRIg RAT!O UNITE-H <br />__ <br />r7 <br />/ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />/ C7 <br />1� <br />UOILERS-ILP. EA-- <br />OO <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />., <br />/ <br />SHOWER <br />FORCED AIR SYSTEMS-8.T,U. M EA <br />KITCHEN SINKS DISK <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />.�.� <br />UNIT HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />WASHER%! <br />EVAPORATIVE COOLERS <br />1 <br />CLOTHES <br />CLOTHES DRYERS <br />WATER HEATER <br />- <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />flANGE HOOD <br />AIR HANDLING UNIT- GF.A1. <br />FLOOR DRAIN <br />-- <br />_ <br />VACUUM BREAKERS _ <br />_STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />ROOF DRAINS-RAINLEADERS <br />WOODSTOVEI F IREPLACE INSERT - <br />SINK ISERVICE-BAR ETC) <br />n IA rP T� l e[�I�. <br />v <br />'6 <br />DU <br />BED <br />SUB TOTAL f 3 <br />SUB TOTAL <br />PERMIT 5 <br />PERMIT <br />-- <br />TOTAL FEE 5-�� <br />TOTAL FEE s <br />' <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />PLAN CHECK FEE <br />REAR SETBACK SIDE SETBACK/ 7z;�: <br />CHECKNUMBER / / A -3, RECEIPTNO (��• <br />• \, _ FEE LOT AREA VA ANT SITE VALUATION FEES = h� <br />VIES ONO <br />'ONST JOCCUPANCY <br />n) <br />GROUP <br />NO OFDWELLINOUNITS <br />BUILDING <br />ILDG O OF STORIES MAX OCL LOAD <br />D G, <br />PRINKLERS REOUIRED O YES ❑ NO <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />110N ACC BY <br />PI7ANSCIIECKED BY <br />APPR FOR ISSUANCE BY <br />IOTAL <br />/ <br />M© <br />