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--APPLICATION FICA <br />IR,All EO�rpmn CONSTRUCTION 0 <br />OF <br />Everett PERMIT <br />WILDING DEPARTMENT <br />159.8745 TO BE COMPLETED IN INK- FLEASE PRINT <br />] DEMOLITION ❑ COMBINATION <br />❑ BUILDING 0 MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />MML ADDRESS <br />CITY <br />ZIP <br />PHONE <br />WHEN <br />RLHIiEGi OR D E510NER <br />MAL ADORE 55 <br />CIw <br />ZIP <br />PHONE <br />CONTRACTOR <br />nIA1L ADDRESS <br />CMY <br />ZIP <br />PHONE <br />LICENSE <br />.ENERAL <br />IiE7j9/s /cF? <br />l/ 1n AuC �1a icct'i9d176 <br />6 o2E712z RQ2L3(eJN <br />�hA 6Y c3EJ11d ALin b <br />cl/119RYSI <br />4LHAWUL CONTRACTOq <br />MAR ADDRESS <br />'LUMBINGCOWRXCTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />;LASS OF WORK ❑ NEW ❑ ADDITION El�.( ALTERATION hl REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />ALUAT1ON OF WORK IC05T OF MATE RIALS PLUS IACORI N. <br />01 <br />9p 3 77 <br />�, <br />DESCRIBE WORN AjO lF <br />RE-cFJFgFLE" Pd9a7- 4F RddP FIUL / - : . <br />- -. <br />I - . —�-- • - ---- - .J.- - <br />IISE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />QE7lSCY✓/iL fi'65/cl'°aJ Ctr <br />_ <br />PLIC/l, I ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OROINANCESGOVERNINGT HIS TYPE <br />lEOAL DESCRIPTION OF PROPERtY15110WH BELOW OR ATTACH TO IR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />�'�[�/ <br />Or � Ar % <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOTJ�-eLOCK_33 <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />r <br />D/ U/S/dN U <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Or CONTRACTOR OR AUTHORIZED AGENT DATE <br />X:2 m G_14? <br />waA <br />A -LICANTS CITY BUS LESS LICENSE NO. <br />PROJCCT AUORE55 <br />/(e32. V/24/n//Y9 7T <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE <br />FEE <br />NO. (YPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA. <br />REFRIGERATION UNITS-H.P. EA. <br />BATHTUB <br />LAVATORY IWASH BASIN) <br />BOILERS-H. P. EA. <br />GAS FIRED A . UNITS -TONNAGE EA <br />SHOWER <br />KITCHEN SINK A DISP. <br />--�T <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />1 <br />WALL HEATERS-R.T.U. M <br />_ <br />LAUNDRY TRAY <br />J <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />URINAL <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK ISERVICE-BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT A <br />PERMIT f <br />_ <br />TOTALFEE 3 <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />RLAR SETBACK <br />SIDE SEISACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />DYES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />f <br />_ <br />SIZE OF BLDG <br />NO Or STORIES <br />MAX. OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />_ <br />OTHER <br />PENALTY <br />BY PLANS CHECKED BY IAPPR FOR ISSUANCE BY <br />L . C. <br />TOTAL <br />eea -tb eoA­­,TFLy <br />�.oaE �s�L,LLRt7-�Lr�.�Z-S_ <br />