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`,r.PFLICATION FORla' [Y <br />p EOF CONSTRUCTION O <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />,/' <br />❑ DEMOLITION ,4COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />MAIL ADDRESS CITY ZIP PHONE <br />OWNER �- - �� I - ­ _ <br />MECHANICAL CONf RALTOq MAIL ADDRESS CITY u. -- <br />CItY ZIP INTENSE <br />- -- <br />PLUMBINOCONINACTOR MAIL ADDRESS PHONE • <br />LiSNEW OF WORK <br />ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRFLANSERT ❑ BUILDING RELOCATION <br />DESCRIBE WORN - - - 11 r- /ell %A _ OI t= V <br />cz,jc,-,)wc,7n% <br />-- - -- <br />USE OF BUILDING <br />I HE EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TOBETRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF PROPERTY ISNOWN BELOW OR ATTACH FOURCOPIESI <br />L €OAL DESCRIPTION <br />D _ <br />It�l� <br />OFWORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />TO <br />[��� - - <br />` LAE <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME <br />LoT_BLOCKLAZ2Xor <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />N <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />V �Fj A5 PEIL <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE.D CONTRACTOR OR AUTHORIZED AGENT DATE <br />_ <br />OI- <br />Lo <br />L.0 S- lT- DY Nlp <br />ADP AN T$LITY BUSINE LICENSE NOV� <br />PROJECT ADDRESS <br />�3I� ��CT1 <br />MECHANICAL <br />PLUMBIN13 <br />FEE <br />TYPE OF EQUIPMENT <br />NO. FEE <br />NO. TYPE OF FIXTURE <br />Q� <br />AIR COND. UNITS-H. P. EA. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS-H.P. EA. -- <br />BATHTUB <br />BOILERS-H. P. EA. -- <br />LAVATCRY(WASH BASIN) <br />43L <br />OAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />SHOWER <br />FORCED AIR SYSTEMS-B.T.U. M EA _ <br />KITCHEN SINKS DISP. <br />WALL HEATERS-B. T.U_ <br />_ <br />DISHWASHER <br />UNIT HEATERS-B. T.0 ME <br />- <br />LAUNDRYTRAV <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />4�.L <br />CLOTHES DRYERS _ <br />HI <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />�- <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT- C.F.M. <br />— <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACES CHIMNEY <br />a0 <br />ROOF DRAINS-RAINLEADERS• <br />WOODSTOVE/f (REPLACE INSERT <br />SINK (SERVICE -BAR, ETC. <br />5 <br />SUS TOTAL II <br />li C7� <br />SUBTOTAL <br />PERMIT ! <br />_ PERMIT ! <br />S" <br />TOTAL FEE ! <br />U <br />TOTAL FEE • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PEHSUNNtL <br />PLAN CHECK FEE <br />SETBACK REAR SE TRACK SIDE SETBACK <br />PLAN CHECK NUMBER <br />- _ r / I I FEE, �� AEC�IPf NI <br />SIZE OF <br />APR[]CAI ION ACC BY <br />AREA <br />VACANTVACANT SITE <br />II IN �� <br />OYES ONO <br />UMNCY GROUP <br />NO. OF DWEI <br />�— I- �-3 <br />OF STORIES <br />MAX OCGYIC <br />FEES <br />FEES VALUATION FEE 1 <br />T 10L I A4 I.DIF 4 J FUE <br />PLUMBING <br />MECHANICAL <br />OTHER Di 1 v e. jj,AlPENALTY r BY <br />TOTAL <br />