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A <br />ITY APPLICATION FOR <br />the cl"or°"'A CONS1 RUCTION V <br />CF <br />everett PERMIT <br />TO BE COMPLETLO IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />,©ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTJVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />USE FIT ND _+ <br />P <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 11'• 3 AP• <br />PLICT TIONANDKNOW THE SAME TO BE TRUEAND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THISTYPE <br />OFWORKWILLBECOMPLETEDWITHWHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. )� <br />SIGNATURE OF CONTRACT ORO TIIORIZEDAOENT DATE7-rI7 " U <br />x <br />T <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW On ATTACH FOUR CO l <br />Lot_BLOCK _OF SN(_ IA�ICS C� l <br />y� <br />PROJECT ADDRESS <br />1"7olt, <br />APPLICAN SCity BUSINESS LICENSE NO <br />MECHANICAL <br />_PLUMBING <br />NO. <br />TYPE OF FIXTURE <br />_ <br />FEE <br />NO. <br />TYPE Of EQUIPMENT <br />FEE <br />WATER CLOSET TOIL El) <br />AIR COMO. UNITS-11. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />LAVATORY(WASH WASH BASI�BOILERS—H.P. <br />EA—H.P. E . <br />_ <br />SHOWER <br />OAS FIRED AO UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />C <br />FORCED AIR SYSTEMS—B.T.U. M EA. O <br />7 <br />DISHWASHER <br />O <br />WALL HEATERS-B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-B.T.U. M _ <br />CLOTHES WASHER <br />IN t3 <br />I <br />I EVAPORATIVE COOLERS-65 <br />WATER HEATER <br />CLOTHES DRYERS <br />CN <br />_ <br />_ <br />URINAL <br />VENTILATION FAN <br />(� <br />o <br />DRINKING FOUNTAIN <br />.7-. <br />RANGE HOOD <br />VLa- <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE E CHIMNEY <br />SINK SERVICE -BAR ETC.) <br />n <br />WOODSTOVE FIREPLACE INSERT <br />SUBTOTAL <br />0 <br />SUBTOTAL E <br />PERMIT { <br />TOTALFEE • <br />PERMIT 7 <br />TOTAL fEE E <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETUAG <br />amE aETUA�a <br />20" <br />2BBrr <br />5'I=-T <br />USEZONE <br />Ey <br />LOT AREA <br />VACANT SITE <br />f� - 2 <br />OYES ONO <br />TYPEOFCOWT, <br />O. UPANCYGBOUP <br />NO OF DWELLING UI <br />V-14 <br />R:3 <br />2 <br />SIZE OF BLDG <br />NO. OF STODIES <br />MAIL OCC. LOAD <br />2�2s s.r-. <br />i1 I <br />Is <br />$S p f3 "'1;17.f` <br />FEES VALUATION ^ FEE <br />BUILDING. E73 0 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY. <br />TOTAL <br />l <br />00 <br />