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APPLICATION FO.. <br />IABEYF"°'"R <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />OWNER MAILL ODRE38 CITY �; ZIP PHONE <br />i(lt'L iin� f% JrA?// ? %4f�tY 5 �1 /4 S/�'!?'i? rm: -;J c 3 ..?O 5— <br />ARCM ELT OR DESIGNER MAIL ADDRESS <br />CITY <br />SIP <br />PHONE <br />GENERAL CONTRACTOR �. MAIL ADDRESS <br />CITY <br />EIP <br />PHONf <br />LICENSE <br />< 4i /, I L:- <br />!fF////NG' <br />/,SEJ <br />MECIIMOCAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />PL UMBING CONTRACTOR MAR ADDRESS <br />CITY <br />ZIP <br />PIIONL <br />LICENSE• <br />CI ASS OF WORM <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ <br />REPAIR ❑ <br />DEMOLITION ❑ <br />WOODSTOVEIFRPLANSERT ❑ <br />BUILDING RELOCATION <br />VALUAIIONOFWORM20STOr MATEmAL3PLUSLASORI <br />DESCRIBE WORN <br />USE or BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONSOF 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 C,LNCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTORORR AUTHORIZED AGENT +�DATE <br />� <br />" �A ' / {!<� ram^ �J Ix� `� <br />APPLICANTS cify BUSINESS LICENSE NO <br />LEGAL OESCRIPHON OF PROPERTYISHOWN BE OW OR AL ACOPIESI <br />LOT alocl`_oF ''� «' <br />/ <br />1/� l � l •, /lJ �� �i� --� � <br />PROJECT ADCALF4 <br />PLUMBIN'1 <br />MECHANICAL _ <br />NO. <br />_ <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />_ <br />WATER :LOSEi ITOILETI <br />4AT4TvC <br />logo <br />I <br />AIR COND UNITS-H P. EA. <br />REFRIGERATION UNITS-H P. EA <br />LA: ATORY WASH BASINI <br />O <br />BOILERS -HP EA _ <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA___ <br />_ <br />KITCHEN SINK E DISP <br />FORCED AIR SYSTEMS-8 T.0 M EA <br />DISHWASHER <br />�F <br />VLF <br />WALL HEATERS-B T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS -BTU M <br />,- <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />RMEAEEP-- <br />/ <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M <br />— <br />VACUUM BREAKERS <br />STOVE <br />_ <br />POOF DRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />_ <br />SINK(SERVICE-BAR ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL B <br />b� <br />PERMIT <br />PERMIT_ B <br />TOTAL FEE <br />TOTALFEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />CA <br />REAR SETBACK <br />810E SETBACK <br />PLAN C�LLEL7 BE0 <br />N <br />EEE <br />CHECK FEE <br />NNO <br />J <br />r, <br />L/7 <br />7 6 c <br />T TC <br />LOT AREA <br />VACANT SITE <br />FE// <br />VALUATION <br />IS <br />I _ <br />IT <br />OCCUPANCY GROUP <br />I NO OF OWELLINO UN!TS <br />BUILDING <br />TIRE Of BL DO <br />NO OF STORIES <br />OAK OCC LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED D YES O NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPIiCAIIONACC BI <br />PLANS CHECKED BY <br />. A <br />APPR FOR ISSUANCE BY <br />G.G. <br />TOTAL <br />7 <br />