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Ids t wc,sn APPLICATION F01%) li <br />°r CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />19L17LTIIl7 <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNt <br />MAIL ADDRESS <br />Glry <br />SIP <br />-- --- <br />� <br />�RG C �%(G <br />Z <br />J <br />� r5-- .2 <br />?ys- <br />ARCHITECT OR DESIGNER <br />MML ADDRESS <br />CITY <br />ZIP <br />PHONE <br />��t./ =UJ^vr�C. <br />) <br />t �� <br />3s"3-e/G.S <br />9 <br />GENERALC NIRACIOR <br />MAIL ADDRESS <br />� . <br />ZIP <br />PHONE <br />_ <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE s <br />PLUMBING CONTRACTOR MAIL AUDRESS CITY ZIP PHONE LICENSE• <br />❑ NEW V )� ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERIALS PLUS LABOR) <br />i <br />NSF �t'J il. UO <br />DESCRIBE WORK 1 / /// <br />I, A I4. J A / /I 4/ IC i / 1 F_ L . L-COL •./ j�. <br />USE OF 4OLDINO �— <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OFWORKWILLBECOMPLETED WITH WHETHER SPECIFIED HERF.- <br />IN OR NOT. THE GRANTING OF A PERMITDOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUC ION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OP AUTHORIZED AGENT DAY Es/ e VC <br />X Y <br />LEOAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COMES) <br />LOT eLocKZoF /3e er!LF /,FFA Au. Z <br />- <br />-- <br />PROJECT ADDRESS ^ <br />/�lv/�:3 S /•CJJ� S / <br />APPII NTS'CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />LAVATORY WASH DASI <br />BOILERS—H.P. EA. <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK& DISP._ <br />FORCED AIR SYSTEMS—B.TU. M EA <br />_ <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />oz <br />O <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />Aso <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_4d, <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLAr ;HIMNEY <br />SINK SERVICE —BAR ETC. <br />_ <br />WOODSTOVE/Flf •LACE INSERT <br />BUD TOTAL <br />SUBTOTAL I <br />PERMIT I <br />/e <br />_ <br />O <br />PERMIT I <br />TOTALFEE t <br />TOTALFEE I <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />TYPE OF CONST. <br />v- &/ <br />BIZE OF BLDG <br />.4bp&l 312 5• <br />eTf_:� <br />Il <br />BACK <br />;RIE SETBACK <br />VACANT SITE <br />DYES ONO <br />'CYGOOUP <br />NO OF DWELLING <br />IZ 3 <br />1- <br />DRIES <br />MAX OCC LOAD <br />I <br />M,A4. <br />Ptorr, • I c1 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />i'6 <br />F/Ur/} FEE <br />EEEB <br />E <br />. , -p � j RECEIPT l9r.464p p, <br />�0 <br />VALUATION PEE <br />:SQ90• `>C <br />ob <br />(O Ob <br />�2 <br />188 �r <br />F(,eu e.iI.4-erg 4%Ec-, 0 <br />