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.,iPPLICALTION FOB, r. rrR <br />CI <br />TY Cm r,F CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING O SIGN <br />"HER MAIL ADOR�gis CITY ZIP MIOHE <br />l�lcc,r,r F S:»,f/, �"c;Ait. Ls � .�If" -/- rr 95�s8 c,s-s j? ess� <br />OOH PAI CONIRACTOn <br />MAT,. ADUOESK <br />CITY <br />ZIP <br />MIUNE <br />LICENSE <br />N1 e•c...,, <br />nfc• t . A., <br />i 5 o P'J <br />MECHAmCAL CONTRACTOR <br />MAP. ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LIC[NAT <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PWpNr <br />LICENSE• <br />41NLLASi M. WVMR <br />Dd NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERI ❑ BUILDING RELOCATION <br />VAL UA ON OF wonr #COST or MA IF WALK PLUS LAF CSI - W <br />BE WOWS <br />LIST Or B-jTiDn.G �r � <br />Ll 7/4 �""�`s"��" S E <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICAT ION AND KNOW THE SAME TORE TRUE ANDCORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORKWILL 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 />ANYOTHER STATE OR LOCAL LAW REPS. ULATINGCONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT DATE <br />ir <br />�4c J G. <br />LEGAL REKC'IPIIONOVPIICPERTYISII NEEnLOWORATA IFOURCOPIESI <br />LOIA�L BLCCF__Or �Ey <br />IF <br />PROJECT ADDRESS, L1' <br />J V <br />APPLICANTSGITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS-H. P. EA <br />BATHTUB <br />O <br />REFRIGERATION UNITS-M.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />_ <br />SHOWER <br />OAS FIRED AC UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK E DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />_ <br />_ <br />DISHWASHER <br />J <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />1v <br />URINAL <br />VENTILATION FAN <br />�IJ <br />DRINKING FOUNTAIN <br />RAf-IE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK ISERVICE-BAR ETC.I <br />W OSTOVEJF REPLA E INSERT <br />_ <br />A An <br />_ 33 <br />[j <br />NStJJ7 <br />BUS TOTAL <br />SUBTOTAL E <br />J_ <br />Vy <br />PERMIT • <br />PERMIT B <br />_ <br />TOTAL FBI! B <br />TOTALPEE B <br />-3 <br />uTrT <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />IR04T SETBACK <br />U 1 <br />REAR BE TWr.K <br />M 0, <br />SIDE SETBACK <br />& F <br />PLAN CHECK NUMBER <br />� 7/ /l rl/ <br />PLANCIIECKTEE <br />FEE ' <br />RECEIPT NO <br />IKE 1011_ 1 <br />11l1CC-11 <br />LOT Jr <br />"CANT SITE <br />Pors ONO <br />FEES <br />VALUATION <br />FEE <br />PIPE Or FORST <br />U of <br />OCCUPANCY GROUP <br />'� <br />NO OF DWELLING UNITS <br />1 <br />BUILDING <br />{� .�0O <br />911E Or BLDO <br />1 . u ,• L 43 � <br />NO OF S PIES <br />MAX OCC LOAD <br />PLUMBING <br />,� J'- <br />10 <br />FIRE SPRINKLERS REQUIRED OYES D NO <br />MECHANICAL <br />)7 <br />OTHER <br />PENALTY <br />�)�)r <br />rArT - <br />- <br />IPPUCATION ACC By <br />, CC <br />PLANSCIIECKEO BY <br />Armrpn I9KUANCE By <br />TOTAL <br />1- /V <br />66 <br />