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InFfveTprFAn �_.PPLICATION FOL- <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION 9COMBINATION ❑ BUILDING O MECHANICAL <br />Cl PLUMBING <br />El rrrtt <br />❑ SIGN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />CLASS Of WORK <br />❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPLANSERT ❑ BUILDING RELOCATION <br />vqV2r�a ��orMA-L-1 wm rBLAao <br />) — <br />DESCRIBE NronK l (fN D ly-• G(JGI C L•UAA.Ly{ I I/C"f v <br />/I /J 1 � .}7 � .�f /i_l.t . � .. Ill. .Clu. �r,.c (a. <br />uaE of�YllBunDIN° <br />rbf <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 />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 PRESUMF TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEO AGENT DATE ID 4 F�j •¢� <br />x/Tz. . .��• J <br />LEGAL DE PTIONOf PERTYIBN 119ELOW OR ATTACH FOUR COPILOT <br />Nr�nF.� <br />_ <br />t �. v C <br />yi <br />r/ �'of. J! <br />PDOJF.CT ADDRESS <br />a / 7'Y" 71L <br />APPLICANTSCITV BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />AIR COND. UNITS—H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY WASH GASPE <br />BOILERS—M.P. EA. <br />8140WER <br />OAS FIRED AC, UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />rl <br />H0 <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS-0.7.1). M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />URINAL <br />I <br />CLOTHES DRYERS <br />VENTILATION FAN <br />Icy_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C. M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE& CHIMNEY <br />SINK ISERVICE-BAR ETC.1 <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />BUB TOTAL & <br />, <br />PERMIT & <br />PERMIT E <br />TOTAL FEE E <br />TOTAL FEE & <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />=RONt SETBACK <br />nEABSETBA K <br />�� <br />BIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE <br />CHECK FEE <br />RECEIPT NO <br />JOE ZONE ! <br />N <br />lOT AIICB <br />lLY/ <br />VACANT SITE <br />DYES TSIT <br />FEES <br />VALUATION <br />FEE <br />"PE OFCCOONSt <br />yf_ � <br />OCCUPANCY GROUP <br />R-31 <br />NO OF DWELLING UNITS <br />/ <br />BUILDING <br />S ' f <br />EIZE OF B BG <br />6 <br />NO OF SIORIES <br />/ <br />MAX OCC LOAD <br />I <br />PLUMBING <br />go <br />U YES NO <br />MECHANICAL <br />.GL1ER <br />PENALTY <br />{CHECKED BY <br />APPN FOa ISSUANCE BY <br />TOTAL <br />oo <br />