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ER.E..,o,..R ''°rAPPLICATION FOr <br />everett CONP� M TTION <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MlkL ADDRESS CITY <br />-%�R%A(� FA-4T C;L'P)o bi ....ter^ r _ zIP PHDNr. <br />-•� vicensLA <br />PLUMBING CONTRACTOR MAIL ADDRE35 CITY ZIP <br />PHONE LICENSE <br />CLASS OF WORK <br />ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ 'A OODSTOVE/FRPI..INSERT ❑ BUILDING RELOCATION <br />VAL W.TION OF WORK [COST Of MAIEHIAI R F, us I .wnw <br />6VEC7"l/) 1)Ii AIAAI Ti . F.. A. <br />USE BUILDING I <br />oA/k(`n (rw J �w f� <br />/OO�FF <br />4r011AA17tZC j/)-r_ <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />LEVAL DESCRIPTION OF 210tTYISHOWN BELOW OR ATTACH FouR COPS} - <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT.ALL <br />PROVISIONS OF LAWS AND ORD114ANCES GOVERNING THIS TYPE <br />LOT _BLOCK _oF_ <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br />IN OR NOT. THE GRANTING OF A PEPNAIT DOES NOT PRESUME <br />TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS <br />-- <br />Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTF UCTION. <br />SIGNATIJ�E F CONTHACTOR OR q VrICRIZED A3ENT DATE <br />nW" 41, 1 <br />V-- <br />PROJECT AODRCdS —' <br />� <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />9z2 /9�hc, Ss evcrzc-rr <br />PLUMBING <br />MECHANICAL <br />TYPE OF FIXTURE <br />_ <br />FEE <br />NO. <br />_- <br />SETITOILE T) <br />TYPE OF EQUIPMENT <br />FEE <br />AIR COND. UNITS-H.P. EA. <br />WASH BASINI <br />L <br />REFRIGERATION <br />EOILEflS-H. P. EA. <br />NKB DISP. <br />GAS FIRED AC. UNITS -TONNAGE EA _ <br />R <br />FORCED AIR SYSTEMS-BT.U. MEA. <br />WALL HEATERSRAY <br />CLOTHES WASHER <br />UNIT HEATERS-B.T.U. M <br />- <br />WATER HEATER <br />EVAPORATIVE COOLER, <br />URINAL <br />CLOTHES DRYERS <br />— <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />— <br />RANGE HOOD <br />FLOOR DRAIN <br />VACUUM BREAKERS <br />AIR HANDLING UNIT- C.F.M. <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />-_ <br />SINK SERVICE -BAR, ETC.)WOODSTO'JE/FIREPLACE <br />METAL FIREPLACE& CHIMNEY <br />INSERT <br />-SUBTOTAL <br />SUBTOTAL 3 <br />PERMIT 3 <br />PERMIT $ <br />_ <br />---_ <br />TOTAL FEE 3 <br />TOTAL FEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />Ir SETBACK REAR SETBACK SIDE SC TRACK rPLAN CHECKNUMEER <br />PLAN GIIEDK FEE <br />!ONE LOt AREA <br />FEE RECEIPT NO <br />SITE DYES <br />OYES pN0 FEES VALUATION FEE <br />OF CONST. OCCUPANCY GROUP NO.OF DWE LLING UNITS <br />SNE OF BLDG <br />NO OF STORIES <br />MA%. OCC. LOAp <br />BUILDING <br />§ <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES D NO <br />- <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATIONACC. BY <br />PLANSCHECK <br />ORISSUANCEBY <br />TOTAL <br />F� <br />� <br />!�>Lc.LU -To 4GL <br />L9LU R-'-lUpTL7 <br />sue. 7�a�U �LJr4, <br />�-©�Mt=.ANTS. <br />