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A _PPLICATION FOE, <br />the EwlpnBn CONSTRUCTIONclr or <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259 8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />,PLUMBING <br />KPtPR <br />O SIGN <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE UCF FISF <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP 1,11014E tICf IHF <br />MAIL <br />M10NF <br />NEWV ^❑ ADDITION ❑ ALTERATION ❑ RE -AIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION INCInKICOST OF M A IF" I AISPtrJDUBOM <br />m ILI <br />DESCRIBE wonKT <br />N <br />USE or eunomo n r(r"' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />WP MA AO e O.7y III? <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCESOOVERNINOTHISTVF'E <br />LEOAtocxmntwNor Pno1,tnTTIgtVlwNnrtowon AnAcNrmincoPIESI <br />OF WORK WILL BE COMPLETED WITH W14ETHER SPECIFIED HERE. <br />LOt_BLOCK OF <br />IN OR NOT. THE GRANTING OFAPERMIT DOES NOTPRESUMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERF MANCE OF CONSTRUCTION. <br />SIGNATURE C TRACT RORAUTHORIZEDAOENt DATE <br />x <br />PROJECT ADDRESS <br />APPLICANTSCITY BUSINESS ENSE NO <br />15-075 715-� .5 t. 5, uJ. <br />� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />No, <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI_ <br />AIR COND. UNITS—H. P. EA. <br />BATHTUB <br />REFRIGERATION UNITS—M.P. EA <br />_._ <br />70- <br />LAVATORY WASH BASIN) <br />AS <br />BOILERS-H. P. EA. <br />SHOWER <br />OAS FIRED AC. UNITS -TONNAGE EA <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />_ <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTNAY <br />UNIT HEATERS-B.TU M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER NEATER10 <br />CLOTHESDRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />-_ <br />FLOOR GRAIN <br />.20 <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS-RAINLEADERS <br />_ <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE -BAR, ETC <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />lqo <br />_ <br />SUBTOTAL <br />PERMIT t <br />_1 <br />PERMIT t <br />TOTAL FEE tS-O <br />TOTAL FEE t <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK 7NLAn SEIBACX SIDE SETBACK PLAIT CHECK NUMBER PLAN CHECK RE <br />FEE nECEIPT NO <br />USE ZONE LOT AnEA VACANT SITE FEES VALUATION FEE -.—_ <br />C/ES ONO <br />TYPE OF C01151 OCOJPMICV GROUP NO OF OMLLING UNITS <br />BUILDING S <br />SITE or FIT DO r10 UI SrORRS MAX OCC LOAD - — <br />PLUMBING <br />MECHANICAL _ <br />FIRE SPRINKLERS REQUIRED O YES O NO <br />OTHER <br />PENALTY <br />APPHCAIIONAfr. BY PI ArISLIIECKfB BY APPII FOR ISSUANCE BY ---� "--"---'- - --- <br />TOTAL <br />