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. APPLICAfION FOB_ e\erell <br />OF°"'° CITfCONSTRUCTION <br />nror <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK _ PLEASE PRINT <br />Cl DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING L781GI <br />OWDERr .�c� WNL ADDRESS CITY Zip RIONE <br />fE' crrrr, p SJ �1X.5%2s�rt'.r %if?s-bao-_ <br />Aarmu cF OaOromNER MAIL ADDRESS CITY ZIP PHONE <br />MI CIIANIC.AI CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />zip P11.lNE <br />LICENSE. <br />PLUMBINOCONIRACHIR <br />MAIL ADDRESS <br />CITY <br />NP II10Hl <br />LICENSE. <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATIOT. <br />,A1 UA11ON OF WORK (COST OF MATERIALS RUB LABOR <br />,J%/) \j -() (•) <br />OESCRINL WORK� \ -' <br />Le- <br />14/ <br />USE Or B1111DIN6 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS Al <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYP <br />OFWORKWILL BE COMPLETED WITII WHETHER SPECIFIED HERI <br />INORNOT THE GRANTINGOFAPERMITDOESNOT PRESUME T, <br />GIVE AUTHORITY "O VIOLATE OR CANCEL THE PROVISIONS O <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE p <br />I EOq DE SCRIPTION or PROPERTY ISHOWN iELOW OR ATTACHfWR CORESI <br />��I000(iI. .��<Lc C- <br />LOI�BLOCK -Or <br />PRONECT ADDRESS <br />APPLI TSCIrY BUST ESSLICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET ITOILE <br />_ <br />%� <br />AIR COND. UNITS—M P. EA _ <br />—y <br />BATHTUB <br />_ <br />_ <br />REFRIGERATION UNITS—H P. EA <br />_ <br />hi <br />LAVATORY WASH BASIN <br />__ _� <br />_ <br />BOILERS—H P. EA. <br />SHOWER <br />OAS FIRED AC. UNITS—TONNAGEEA <br />or <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />_ <br />_ <br />_ _ <br />WALL HEATERS-8 T.U. M <br />_ <br />_ <br />_ <br />LAUNDRY TRAY <br />__ <br />UNIT HEATERS—B T.0 M <br />_ <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />URINAL <br />Q� <br />_ <br />DRINKING FOUNTAIN <br />_ '-- <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DFIAINS—RAINLEAVERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE—SAR.ETCI <br />WEODSTOVHFIREPLACE INSERT__ <br />BUD TOTAL S <br />MIT _! <br />_ <br />SUBTOTAL <br />_PERMIT_ <br />TOTAL FEE S <br />_ <br />TOTAL FEE_ S <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />20T <br />/1. N(�E 1.1 <br />FEE �'"':Af, <br />ECjIPI No <br />IBt tI NL <br />LOT AREA <br />vACijNUNoI SITE <br />.QFF6 <br />rtEB <br />VALUATIONFOR <br />YI•t Or CONSI <br />—0 <br />OCCLI GROUP <br />ANCY —3 <br />NO OF DINT. LINO UNITS <br />BUILDING <br />PLUMBING <br />S.. <br />NR OF BL DU <br />1157.4 d-84- <br />NO OF 5100IE5 <br />MAX DOC LOAD <br />'IRE SPRINKLERS REQUIRED O YES O NO <br />MECHANICAL <br />e <br />OTHER <br />PENALTY <br />L <br />iPP1ICAIgN Aft BY <br />PI ANB CHECKED BY <br />�E <br />APPO FDA ISSUANCE BY <br />� J � <br />TOTAL <br />----- <br />- <br />