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'"" <br />F�PPLICATION FOk, <br />tYEFflI <br />DF <br />cITYof <br />1n <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259-8745 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />O SIGN <br />JWq[q ��- <br />��/✓ Vr✓lt/J10� <br />MAII ADDH[55 Lrtv ZIP <br />/7z�'i <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />"1 <br />2 <br />DD. <br />A<55l:/ Z�V 2o3 <br />L / �[(� <br />GE�%%lCCy"C <br />PHONNEE <br />JI •,�// <br />P[.A�� <br />MECHANICAL LONT CTOR <br />MAIL ADDRESS CIIVY ZIP <br />HONE 2 <br />LICENSE <br />PLUMB 6CON <br />TRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE <br />�� l�4,N7 l >l� <br />CLASS OF WORK' Fes(/ <br />❑ NEW ❑ ADDITION ❑ ALTERATION !(REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />JALUALON OF WORHIIIE257 OF MATERIALS PLUS LABOR) <br />V <br />JESCRIBE WORK <br />.f P.Vf of /il n/nY� /a ,4..1 � :, 'T I ✓T!w rP P_C <br />JSE OF BUILDIN�p/, <br />/IPS/V (��i/CF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION A NO KNOW TH E SAM E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X�% <br />- <br />.EGAL OMPIP71OR OF PROPERTY (SHOWN BE: OW OR ATTACH FOUR COPIES) <br />-OT_BLOCK--OF <br />ROJECT ADDRESS <br />CI n n7- <br />APPIICANTSCUY BUSINESSLICEN ENO <br />'Lumalmo <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H. P. EA. <br />_ <br />BATHTUB <br />REFRIGERATIUNITS-H. P. EA <br />LAVATORY (WASH BASIN) <br />BOILER$-H P.ON EA. <br />SHOWER <br />GAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK A DEEP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNITHEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />R <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />WOODSTOVE <br />FI CE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />PERMIT i <br />� <br />PERMIT f <br />TOTAL FEE f <br />�' <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />INE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />FEET <br />VALUATION <br />FEE <br />F CONST. <br />OCCUPANCY GROUP <br />NO, OF DWELLING UNITS <br />BUILDING <br />S <br />I <br />F RI OI: <br />Nn n, STORIFS <br />MAKOCC LOAD <br />PLICATION ACC BY <br />'�A <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />BY <br />TOTAL <br />