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"PPLICATION FO.a <br />CIry EOF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL <br />DINNER MAIL ADDRESS CITY r _ Z <br />IP <br />❑ PLUMBING <br />4 <br />❑ SIGN <br />CLASS Of WORK <br />I� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK 1tA Of NNIAL9 PLUS LASORI <br />��� <br />DE371BE WORK <br />Y L v <br />- - <br />USE OF EDILOIND <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />S <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPHON OF PROPERTY 1SHOWN IELOW OR ATTACK FOUR COPIES) <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIE ,ED HERE- <br />LOT_BLOCK _OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO. <br />GIVE AUTHORITY.TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY O-L HER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE Oq CONSTRUCTION. <br />SIGNATURE OF C NiRACi �®RiH0 EO AGENT DATE <br />Y//� <br />X 2�- <br />PROJE TADDRESS <br />APPLICAN BUSINESS ULENSE O. <br />2' Ru cK <br />PLUMEING <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />-2, <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />_ <br />LAVATORY IWASH BASIN <br />BOILERS-H.P. EA. <br />SHOWER <br />_ <br />GAS FIRED A C UNITS -TONNAGE EA <br />KITCHEN SINK DISP. <br />FORCED AIR SYSIEMS_B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />-_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B T.U. M <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS_--- <br />- <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />'Z <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/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL E <br />f <br />PERMIT E <br />PERMIT t <br />__ <br />TOTAL FEE I <br />_ <br />TOTAL FEE I <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IRONY SETBACK REAR SETBACK SIDE 5ETBAOK ^LAN CHECK NUMBER PUN GIIECK TEE <br />TEE RECEIPT NO <br />FEES <br />USEZONE LOIAREA VACANT SITE VALUATION FEE <br />_ <br />OYES ONO ---- <br />TYPE OF CONST OCCUPANCY GROUP NO OFDWELLING UNITS <br />BUILDING S <br />SIZE OF BLDG NO OF STORIES MAX. OLC LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPP'MKL ERS REQUIRED O YES D NO <br />OTHER <br />PENALII' <br />APPIICATIONACC By PLANS CHECKED BY APPR FOR ISSUANCE BY <br />TOTAL <br />