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..PPLICATION FOl_ <br />fonOf "'n CONSTRUCTION <br />Eeverett PERMIT P+ <br />BUILDING DEPARTMENT <br />2s9-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION Fl COMBINATION ❑ BUILDING ❑ MECHANICAL 11 PLUMBING ❑ SIGN <br />OWNETo MAIL ADDNLSS con 'T-1-SIP PHONE <br />�, t'w3L► l�ft1L /C�/ Low '6;- f-IJE1I�f'11 /XiOC; jL^�j�,;33� <br />ARCHII[. OR OF$IGNIR S. An011 SS CITY TIP PHONI: <br />GENERAL CONTnAC1On <br />n(� <br />MAIL AOnnE SS QIn <br />ZIP <br />PHONE nLENSE . <br />AJ(Iklwl 5niij <br />Ifucl <br />Y, 92c)b :Out, 13( I3luc1 MA <br />I. �dtl _. % <br />�n <br />� L_ ]a/Wt Bs. <br />��'/+ tLICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS J CITY <br />I n"I�,, <br />• <br />�ILUMBING CONTRACTOR <br />MAIL ADDRESS Con <br />ZIP <br />PHONE 1ICE NSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION JO HEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ HUILDING RELOCATION <br />IAL U�FI IN OF WORK (COST Or MATE RIAI S PI US L ABOR1 — <br />FALALJ11e r1-rIn►i E r.Aril.'I? i=V l<.-T Jwk _57 L�lICTll l�f <br />usE or o,JR DIN1G <br />t? <br />IC 6 ;CSAME - �_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />TALL <br />C TRUEANDLNG THIS <br />PROVISIO AND KNOW THE ORDINANCES <br />PROVISIONS OF LAWS AND ORDINANCESGOJERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WIT H WHETHER SPECIFIED HERE• <br />IN OR NOT. TI IE GRANTING OF A F ERMIT DOES NOT PRESUME TO <br />GIVE ALIT IORITY TO VIC LATE 0 1 CANCEL THE PROVISIONS OF <br />ANY Off IEH STATE OR LCI.. L LAW REGULATING CONSTRUCTION <br />OR I HE PERFORMANCE Of CONSTRUCTION. <br />sIUNATNRr11�I1r cuNTRArroR Oil AUTHORIZE ul:Nl DATE <br />mil_ sritn 87 <br />ImAl DeswmuDN OF Pnovcr rYlsNowN BELDY!On AnealrouReoP'EEI <br />�l <br />13C LJ(:,p � �I <br />IOT—_BIOCN—OF_. Fmk AI Cq' <br />B C0,2 !, I - Ii AE V) .7 )N tyre J I>Zf-I <br />54) for <I� Of-D W/NT R A� .OaILE � <br />3 `7 3 - coo a 0c, nLI.,V <br />PROJECT ADDRESS <br />/6 10 �re= c�Ic <br />A PIIGN FSCITY FRVANESS I ICE SEND <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_______ <br />TYPE OF EQUIPMENT_ <br />_ <br />WATER C LOSET(TOILE T) <br />_ <br />_ _ _ <br />AIR CONE. UNITS -HP EA <br />_FEE <br />BATHTUB <br />_ <br />REFRIGERATION UNITS- It P. EA. <br />LAVATORY(WASH BASIN) <br />_ <br />_ <br />BOILER' -TIP F.A. <br />SHOWER <br />J <br />GAS FIRE-) A C UNITS -TONNAGE EA <br />KITCHEN SINK E DISP. <br />FORCED AIR SYSTEMS-8 T.0 M EA� <br />DISHWASHER <br />_ <br />WALL HEATERS-BT.0 M <br />LAUNDRY TRAY <br />UNIT HEATERS- BTU M_ <br />_ <br />CLOTHES WAS14ER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN _ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />DRAIN <br />AIR HANDLING UNIT- CF.M <br />_FLOOR <br />VACEIUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEAOERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BA' ETC( <br />WOODSTOVEFFIREPLACE INSERT <br />--i <br />SUBTOTAL <br />_ <br />_--. SUBTOTAL <br />_. <br />PERMIT <br />TOTAL FEE ___-_ <br />B <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PI ANCHECK NUMBER // PLAN C14ECK FEE <br />' //I .t- I I FEE // -:I RECEIPT NO �J � <br />USE ZONE LOT AREA VACANT SIR f FEES VALUATION FEE / ores uu0 — <br />TYPE OFCONST OCCUPANCY GROUP NO OF DWELLING UNITS <br />SIZE OF DI DG ilia <br />FIRE SPRINKLERS REOUIREO ❑ YES D NO <br />ATION ACC BY PI ANS 0IECKEO BY API-0 Von <br />1 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />f <br />