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IIA.EI.pMR <br />�'PLICATION FOIE <br />7 CITY OF <br />CONSTRUCTION <br />3 everett <br />PERMIT <br />BUILDING DEPARTMENT <br />259.8745 <br />TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION O COMBINATION tBUILDING ❑ MECHANICAL <br />❑ PLUMBING Cl SIGN <br />PHONE <br />.3 eNJn 3 <br />I <br />GENERAL CONTRACTOR `, MAIL ADDRESS <br />CITY <br />LP PHONE <br />LICENSE A <br />.� MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />TIP PHONE <br />LICENSC <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY, <br />ZIP PHONE <br />LICENSE <br />CLASS 01 WORK <br />❑ NEW ❑ ADDITION <br />Q ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ <br />WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />uA ID Or WORK wsl ur •LJ r'LV1LKKum <br />PSd_Sie 0 /he(' <br />Sir. s�/ • ��i�,, /V <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />pgOVISIONSOFLAWSANDORDINANCESGOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />INL)RNOT.THEGRANTINGOFAPERMITDOESNOTPRESUMETO <br />GltE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP <br />AN" OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR TILE PERFORMANCE OF CONSTRUCTION. <br />SIGNA•URE OF CONTRACIOR OR AUTHORIZED AGENT DATE <br />LEae DE 110NOFPROPERTYISNOWNBEIO/WORAtLCMFOURCOPlE61 <br />LOT BLOCK OF �r�tL/��/P_ <br />'T/ <br />PROJECT ADDRESS <br />APPLIOANTSCIIY OUSINESS LICENSE NO J�— <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSETITOILE <br />O <br />AIR COND. UNITS—N.P. EA <br />BATHTUB <br />C <br />REFRIGERATION UNITS—H. P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H P. EA. <br />SHOWER <br />GAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN SINK A DISP. <br />LF <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />D <br />WALL HEATERS—B.I.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERSS <br />URINAL <br />VENTILATION FAN <br />— <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLfA DERS <br />_ <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />W O <br />STOVE/FIRE LACE INSERT <br />BUD TOTALtz� <br />SUBTOTAL L <br />PERMIT L <br />PERMIT L <br />TOTALFEE $ <br />TOTALFEE 6 <br />USE ZONE <br />I <br />TYPE OFF-CONSI <br />Z— <br />THIS PORTION TO BE COMPLETEC BY BUILDING DEPT. PERSONNEL <br />FEAR SETBACK <br />SIDE SETBACK <br />PLAN CNECN <br />rUMBER <br />PLAN CHECK FEE/� <br />,1U <br />�, <br />�yl�II�C'�J <br />V <br />FEE /J <br />( RECE OPT NO 605 lc_ <br />�-�A?% <br />L OT AREA <br />V/�CANT SITE <br />D <br />ALUFT <br />FEES <br />VALUATION <br />IEL <br />flQ�Li VO i i- <br />iIYEB ONO <br />I <br />FIRE SPRINKLERS REOUIRIM ❑ YES D <br />APPLICATION ACC BY PLANE CHECKED BV <br />I <br />APPR FOR ISSUANC <br />L -c <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHSA <br />PL .TY <br />TOTAL <br />