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`APPLICATION FOLD' lYEFB„ <br />the OlPf EOF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION A! BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />D <br />7 <br />MAIL <br />R T(L <br />DING CONTRACTOR MAIL ADDRESS <br />CITY ZIF PHONE IILEHSE• <br />C a-(_ <br />I OF WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERF ❑ BUILDING RELOCATION <br />C / \ or-41 <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 />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 OF <br />AN OTVSTA�TEOAWREGULATINGCONSTRul:nory <br />NSTRUCTIO 4.$IG <br />TURRIZED <br />AGENT DATEX <br />PRO .T ADDRESS <br />APT NT <br />or v r <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF FI%TURF <br />FEE <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UN ITS-H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA <br />LAVATORY (WASH BASIN) <br />O <br />BOILERS-H. P. EA <br />GAS FIRED AC. UNITS -TONNAGE EA <br />SHOWER <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS-B.T.U_M EA. <br />DISHWASHER <br />WALL HEATERS- R.T.U. _M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.I.U. M <br />— <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS _ <br />WATER HEATER <br />_ <br />CLOTHES DRYERS <br />URINAL <br />�+ <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 />— <br />ROOF DRAINS-RAINLEADERS <br />_ <br />METAL FIREPLACE A CHIMNEY <br />—� <br />(JV <br />WOODSTOVE/FIREPLACE INSERT <br />SINK(SERVICE-BAR. El C.I <br />SUBTOTAL fIT <br />OTAL <br />PERMIT f <br />r==�PCF f <br />TOTAL FEE f <br />TOTAL FEE D <br />D _ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SET8ACK PLAN CIIECK NUMBER 2 PLAN CIIECK FEE <br />O p FEE RECEIPT NO gv q lnl <br />OSE ZON LOT AREA VACANT SITE (J FEEB VALUATION FF. EUU VV iiI LVl <br />(05�75 Sf <br />RiES ONO <br />FYPE OF CONST <br />OCCUPANCYGROUP <br />NO. OF DWEL <br />ZLC- �l <br />!3-Z <br />0 <br />SIZE-4 <br />G <br />G-40 ST <br />NOOF SIOPIES <br />��/E�� <br />IMAX OCC LC <br />/09 <br />CATION ACC BY BY <br />PLAOSCIIECKED BY <br />APPR. FOR ISSUANCE <br />1A 'm , <br />J W. <br />6 . <br />BUILDING / <br />PLUMBING <br />MEC14ANICIlAY�L <br />OTHER ITI17 <br />PENALTY <br />TOTAL <br />