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APPLICATION FOk P,r1111 <br /> the <br /> F°"" <br /> Corr6F CONSTRUCTION O <br /> DIA DA <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259.8810 TO BE COMPLETED IN INK• PLEASE PRINT <br /> O DEMOLITION ❑ COMBINATION KBUILDING ❑ MECFIANICAL O PLUMBING n SIGN <br /> MAIL ADORC9S Clly I L lir MITN[ <br /> 7y"/�I/ n � � �dli'L�• n 6sog ccenmerc;nt FI&"cA FTI n)�7�'4 3S'7- 0li 5 <br /> ♦RCN L f0 rf rEN <br /> MAIL DDRESS Cl ry 'ir nln"I <br /> nCNtR4 F oonTACIOR AI tnnnEaK rnv nr nP�111 nrl•r'r .— <br /> S`l" mCi- c'-- SGq Com inerclf l ��t'i� s t,7r" <br /> MECIIANW ONIRECTon MAIL ADDRESS CITY IIP rTON1 UC1-111 <br /> nuMBINTCOIIInActon M,It fDODCIs CITY OI` I'1.0N1 IK 111-1 . <br /> CLA59'Jf WORK <br /> NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION A WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAtIOTI <br /> VAl UAPON a;g' COSI 01 MAlt RML 5 Pl AHTrb — -- <br /> r'� <br /> AIR 'jT1 , �L, �wv —" y, rrxn <br /> DESCRiDE WORK ' <br /> us[of DIVIDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIIIS AT` <br /> PLICATION AND KNOW THE SAME TO BE TRUE AND CORREC' ALL <br /> LEGAL DESCRVNOn Ot PROPL RT Y-SHOWN BELOW OR ATTACH TWA COPASI PROVISIONS OF LAWS AND ORDINANCES GOVERNING T ITIS Tv PE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE. <br /> Lol__BLocK_oF__ IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> SQL ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATUOEOI CONInACTORORAUTIJOINZEDAG[ I [,.IT <br /> LZ \ ---�— 1` �c— <br /> PROJECTADDRES3 APPUCANTI 11 BUSINESS ICLIVIF ND <br /> d +t, ep-() <br /> PLUMBING MECHANICAL <br /> TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET ITOILETt AJC-A,HNOLO UNITS-H P <br /> BATHTUB I REFOIDERATION UNITS—HP EA <br /> LAVATORY IWASH BASINI 15 BOILERS—B.TUMP <br /> i SHOWER RAS FIRED A C.UNITS-8 TU <br /> KITCHEN SINK A DISP FO'ICEO AIR SYSTEMS—B T U M EA <br /> DISHWASHER 10i WALL Hi-,Ens—BTU M <br /> LAUNDRY TRAY UNIT HEATERS—8.T U M <br /> CLOTHES WASHER _� EVAPORATIVE COOL ERS ' <br /> URINAL Z CLOTHES DRYERS ,1 -1,1` <br /> DRINKING FOUNTAIN VENTILATION FAN <br /> FLOOR DRAIN RANGE/1000 <br /> BACKFLOW PREVEN`Ens _ _� WATER HEATER r 1! \ <br /> ROOF DRAINS—RAINLEADERS WOOD STOVE <br /> SINK 1SERVICE—BAR ETC) METAL FInEPLACE A CHIMNEY I 1 1 <br /> FIREPLACE INSERT <br /> HEAFPUMP <br /> GAS PIPING _ <br /> EXHAUS77AN <br /> SUBTOTAL t -1 o SUBTOTAL f 1l \ <br /> PERMIT f - - PERMIT <br /> TOTAL FEE 21 TOTALFEE <br /> 1 <br /> 46Ni'SF 1nY:r. in ATT,i v;AEK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br /> 2D '-A <br /> LISI PRO IDT AVIA VASA111511E ;T FEES VALUATION FEE <br /> R -Z P(FB nNo <br /> ry PE BUILDING so `r <br /> OT(.0.151 .r TrOIcY.noun NO OF DWFLlltJO IINIT9 <br /> PLUMBING <br /> 411E OF BIW IIT nr :IONER MAX OCC LOAD <br /> z3/G sF MECHANICAL <br /> TF s .Y,, . OTRER _ <br /> FIRE SPRINKLERS REQUIRED ❑ YES kNO STATE BUILDING SURCHARGE j 1 <br /> STATE ENERGY SURCHARGE ' Il t,`I <br /> AVPI r[tTnN.;! p• r�nlSl;uECKCO By Arm FORISSUE B <br /> ANty _— _---- — <br /> ,jcy./ FL,` rueur.wonLs <br /> �• �1,/T TOTAL •T , r� ,1, <br /> d PROPERTY OWNERS ARE RESrONSIBI.E FOR OCIERMINING ALL <br /> PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />