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,,PPLICATION F01% <br />CITE"°'°'"B <br />� <br />LILY OF <br />CONSTRUCTION <br />everett <br />F <br />PERMIT `v= <br />' <br />TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />a <br />MAIL ADDRESS CITY TIP PHONE <br />if— <br />I c' ► I— 7 5 �,,a. e -- <br />ARCH ICCTT.�O-n2:818ONNEER // <br />ffl <br />MAIL CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADORERS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING C NTRACTOR <br />MML ADDRESS CITY ZIP PHONE LICENSE <br />W. uS7L P. <br />�, fL <br />2 v - 4 'S �g I'l .Q�%TawA"...0 i L.Jay Rogo w 19'{ fe <br />CLASS OF WORN <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOBI OF MAIENIALB PLUS LABOTR <br />z <br />O <br />OQ <br />� <br />O �. <br />n <br />DESCRIBE WORK <br />WORK w ecWA— <br />11 ( <br />a..l�i LT�FAi ( �! AiAAp IAx FL� fL7 .ed � t ' �•^ <br />m <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 ANn CORRECT. ALL <br />LEGAL DESCRIPTION Of PROPERTYI914OWN BELOW OR ATTACH FOUR COPIES <br />PROVISIONS OF LAWS AND ORD I NANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIEDHERE• <br />om <br />LOT_BLOCK—OF <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />m o <br />ANYOTHERSTATEOR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />o <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />1 7_I <br />rn <br />X J-3- 8S <br />g= <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO <br />_ <br />N <br />PLUMBING <br />MECHANICAL <br />m <br />ox <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I' RILE <br />i <br />AIR COND. UNITS-H.P. EA <br />= <br />i <br />BAT/:TUB <br />REFRIGERATION UNITS-H.P. EA <br />/ <br />LAVATORY WASH BAST <br />ID <br />BOILERS—H, P. EA. <br />w <br />SHOWER <br />OAS FIRED AC. UNITS —TONNAGE EA <br />KITCHEN STINKS DISP. <br />A <br />00 <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />N <br />DISHWASHER <br />D <br />WALL HEATERS—B.T.U. M <br />i*1 <br />Z c- <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />--1m <br />CLOTHES WASHER <br />100 <br />EVAPORATIVE COOLERS <br />A <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />S <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />= <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE • CHIMNEY <br />v, <br />SINK SERVICE —BAR ETC. <br />WOOOSTOVE/FIREPLACE INSERT <br />Z <br />p <br />m <br />m <br />BUS TOTAL <br />OU <br />SUB TOTAL • <br />PERMIT <br />• 01 PERMIT _ • <br />TOTAL FEE <br />• A _ TOTAL FEE__ _ • <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SEIUACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO <br />USE ZONE <br />FEE <br />LOTAREA <br />VACANT SITE <br />F[ES <br />VALUATION <br />DYES ONO <br />— <br />TYPE OF CONBI. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />13UILDINO <br />• <br />SIZE OF BLDG <br />a <br />NO. OF STORIES <br />MAIL OCC LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED LT YES <br />❑ NO <br />OTHER <br />PENALTY <br />APPLILAl10NACC BY PLANSCIIECKED BY APPO FOR ISSUANCE BY <br />TOTAL <br />