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�..IPLICATION FOR <br />1AF EY.J°`"R CONSTRUCTION evert," <br />.:F <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION Al COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNE�D)) MAIL ADDRESSCITY ZIP PHONE <br />;Icll.4,all /"/14 L/E>`-• AB/oi/Z*1L zv"'0/.i` 0, G,7 7 ) � iC•. C � n <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />OFF <br />ZIP <br />PHONE <br />GEN/ER CONFRACTOR <br />W H.Q Ce.y <br />MAIL AOpREB <br />%R LKi%lL/�. L� Z6Z <br />M CITY <br />'e /aue4,0 <br />ZIP <br />Z/ <br />PHONE <br />29k -Ob <br />LICENSE <br />&w,44g--e1Sl) <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />1N1ONE <br />LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL.INSFRT ❑ BUILDING RELOCATION <br />"I'{ L- -y <br />USE OF BUILDING IF <br />�r 'i <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOWTHE SAME TO BE TRUE AND CORRECT. 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 />SIGNAIUREOFCONICTORORAUIHO EDAGENT OA E <br />LEGAL DESCRI ION OF PROPERTYISHOWN BELOW OR ATTACH FOURCOPIES) <br />J <br />Lor�eLocK_oF /LU.eT� v7 <br />n <br />/' <br />Z)l L SP 00pOS! Z/o/PC2 <br />PROJECT ADDRESS <br />APPLICANTS CITY OIISINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />-0 <br />(Y) <br />_ <br />AIR COND UNITS_H P. EA <br />BATHTUB <br />Q <br />Q0 <br />_REFRIGERATION UNITS-H P EA. <br />fj <br />LAVATORY WAS" BASIN. <br />so <br />00 <br />_ <br />BOILERS-11. P. EA. <br />SHOWER <br />_ <br />GAS FIRED A C UNITS -TONNAGE EA <br />ZL <br />KITCHEN SINK A OISP. <br />(j <br />FORCED AIR SYFIc_IAS-D TU MEA <br />DISHWASHER <br />WALL HEATERS - BTU. M <br />LAUNDRY TRAY <br />_ <br />UNIT HEATERS-B 7.0 M <br />CLOTHES WASHER <br />10 <br />w <br />EVAPORATIVE COOLERL <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />L <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_Le.LL <br />_ <br />FLOOR GRAIN <br />1114 HANDLING UNIT- CF.M <br />VACUUM BREAKERS <br />ROOF DRAINS-RAINLEADERS <br />_STOYF <br />METAL FIREPLACE / 'IIMNEY <br />sdl <br />SIIIK SERVICF.-BAR, ETC <br />WOODSTOVE/FIRE, ..CE IHSERT <br />SUB TOTAL <br />SUB TOTAL <br />PFRMIT f <br />'_ <br />PERMIT <br />TOTALFEE f <br />(:/V <br />TOTAL FEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />BACK <br />) I <br />REAR SETBACK <br />SIDE BE TRACK <br />"!' Y <br />PUN CHECK NUMBER / <br />1 66 Low / <br />PI AN <br />FP <br />CHECK FEE <br />RECEIPT NO <br />LOTAREA <br />VACANT SITE <br />YES ONO <br />FEE■ <br />FEE <br />_VALUATION <br />INST <br />OCCUPANCYGROUP <br />I NO OF CWELLINGUNIT9 <br />'BLDG NO OF STORIES <br />+ <br />PPLK�AIIONBY (PLANS CHECKED BY IAPPP FOR ISSUANCE BY <br />;; 2C1-1 L G <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />s-J <br />