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APPLICATION FG.: <br />TAF EYFIE-AAD <br />O <br />FIT, GF <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />259 8745 <br />n DEMOLITION o COMBINATION <br />❑ BUILDING 0 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNLR <br />MAIL AODPEBB CITY ZIP PHDIFE <br />isms 1 <br />cT <br />l►LCT4 <br />MAIL ADDRESS CITY ZIP PIONL <br />ANCBOOROLSIUNER <br />GLNI NAL CONTRACTOR <br />MAIL ADDRESS CITY EII PILGNf IICENSE <br />J. <br />a.'4 Z"e,. <br />MECNANICAI CONTRACTOR <br />/III'<.4/rC+ I <br />MAIL ADDRESS CITY ZIP PNOIIL LICENSE <br />PLUM1111PICOHIRACTOR <br />MAIL ADDRESS CITY ZIP PIKINE LICENSE• <br />CLAS OF WORE <br />❑ ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />❑ NEW ADDITION <br />VAI UATIJTI O( W,LOR%n (COST Of AIAIERMLB PLUB LABOIB <br />; , <br />Df SCRNIL WON• <br />• ! <br />USE OF atilt ONTO 1 3, : • ( <br />.14 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />THE SAME TOBETRUE AND CORRECT, ALL <br />, �- / r/9il/i� <br />PLICATIONAND KNOW <br />LLOAL OLSCRIPTION OF PROPERTY I51101!N 0ELOW RANALH Fou�E51 <br />PROVISIONS OF LAWS AND 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 i0 <br />LOT =BLOCK— - <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED A M.LPH DATE <br />/y <br />APPL ICANTS CITY BUSINESS LICENSE NO <br />PROIECIADDRESS <br />MECHANICAL <br />PLUM <br />NO. <br />NO __ <br />___ <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE, <br />TYPE OF FIXTURE <br />WATER CLOSET TOILET) <br />AIR COND. UNITS-H.P. EA <br />REFRIGERATION UNITS-H P. EA. <br />"( <br />--�- <br />BATHTUB <br />LAVATORY WASH BASIN) <br />BOILERS-H P. EA. <br />GAS FIRED AL: UNITS -TONNAGE EA <br />SHOWER <br />�-t- <br />FORCED AIR SYSTEMS-B.T.0 M EA <br />KITCHEN SINKA DISP <br />SITLi <br />WALL HEATERS-B.T.U. M <br />DISHWASHER <br />DISHWAY ER <br />UNIT HEATERS-0 T.0 M <br />LAUNDRCLOTHES <br />EVAPORATIVE COT: ERB <br />WASHER <br />CLOTHES DRYERS <br />-� <br />WATER HEATER <br />NTILA IOftFAN <br />URINAL <br />RANGE HOOD <br />(- <br />_-_J'j <br />- <br />DRINKING FOUNTAIN <br />IR HANDLING UNIT- C EF M- <br />FLOOR DRAIN <br />STOVE <br />_ <br />VACUUM BREAKERS <br />METAL FIREPLACE A CHIMNEY <br />ROOF DRAINS-RAINLEAOERS <br />WOODSTOVEI7FFII-�RR,�-EE- LACE INHRT <br />SINKjSERV10E-BAR. ETC <br />BUR TOTAL B <br />EUE TOTAL <br />— <br />PERMIT <br />PERMIT <br />R <br />TOTAL FE! B <br />_ <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />NEAR SETBACK <br />BIOS SETBACK <br />FLAN GIIEDK NUMBER <br />PLAN CHECK FEE <br />RECEIPT NO <br />(r <br />FEE <br />1 <br />-- <br />USE ZONE <br />LOI APEA <br />VACANT BITE <br />FOB <br />VALUATION <br />KBB <br />OYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO Of DWELLING UNITS <br />OD <br />gLA <br />BUILDING <br />B �p <br />suE of Blau <br />NO OF STORIES <br />MAX occ LOAD <br />s <br />PLUMBING <br />,1✓_ <br />ow <br />19) <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED O YES <br />O NO <br />OTHER <br />PENALTY I <br />APPI WITION ACC BY <br />Kl115 CNECKLO BY <br />APPR IORISSUANCE BY <br />TOTAL <br />