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FM ELwg~ -APPLICATION FIG <br />LITY OF CONSTRUCTIOi; <br />everett PERMIT �+ <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION O BUILDING O MECHANICAL I] PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECIIANICAL CONTRACTOR MAIL AOOP-SS CITY ZIP PHHNE LICENSE. <br />N19 <br />3:4fI /.L7 ? .. <br />❑ NEW ❑ ADDITION CH ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLAE SERT ❑ BUILDING RELOCATION— I <br />VAT UATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />—. A SO a U <br />•.I P LI f, A I— i%IA A Yi..AA i", A—,; <br />USE OF HIM DING <br />rl OCA��� (n F <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP. <br />PLICATION AND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND 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 />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR 1OR AUTHORIZED AGENT DATE <br />APPLICANTS CITY BUSINESS LICENSE N ' ' <br />LEGAL DESCRIPTION OF PROPERt (SHOWN BEL OW OR ATTACH FOUR COPIES) <br />LOT— BLOCK _OF <br />.� I <br />PR JECT ADDRESS <br />_ `16 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />F_EE <br />_ <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H P EA. <br />_ <br />_ <br />BATHTUB <br />REFRIGERATION UNITS -EL P. EA <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />BOILERS-H. P. EA. <br />SHOWER <br />G"S FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />_ <br />FORCED AIR SYSTEMS-B.T.U. EA EA <br />DISHWASHER <br />WALL HEATERS-B T.U. M <br />LAUNDRY TRAY <br />UNIT H iATERS-B T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER _ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />PANGE HOOD <br />FLOOR DRAIN <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 />SUB TOTAL <br />PERMIT f <br />TOTALFEE 3 <br />SUBTOTAL f <br />PERMIT f <br />TOTAL FEE f <br />_ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />OYES ONO <br />TYPE OF CONST <br />OCCUPANCY CROUP <br />NO OF OWELLIN9 UNITS <br />SIZE OF DI DO <br />N0 OF STORIES <br />MAX OCC LOAD <br />FIRE SPRINKLERS REQUIRED 0 YES ❑ NO <br />APPTICAtIONACC. BY <br />I PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO <br />FEES I VALUATION I FEE <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />