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I <br /> I <br /> _ :PPLICATION FO'.' <br /> C'TYO'° 'G CONSTRUCTION <br /> everett PERMIT e <br /> BUILDING DEPARTMENT <br /> 259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESS CRY ZIP PHONE <br /> STT P0.rfncrSh�L� Po fou 5AI4 I` VCrL_lf wA 337-[ogs4 <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> .Yby)ftS IJLJSK• PC1 t?JCrx . E_5)q( U2 It it k1A '337- toIS, <br /> MECHANICALO TRACTOR MAIL ADDRESS CITY ZIP PHONE "CENSE F <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> FN67L6 �� SI'r' C��A�ri1=s <br /> CLASS OF WORK <br /> X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSE RT ❑ BUILDING RELOCATION <br /> VALUATION OF WORK(COST OF MATCRIALS PLUS LABORI <br /> S6000 <br /> DESCRIBE WORK � I <br /> USE OF BUILDING <br /> _ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> PLICATIONANDKNOWTHESAME TOBETRUE AND CORRECT.ALL <br /> PTIO PR <br /> 1 <br /> LEGAL DESCRIFOPERTYISHOWN BELOW DR ATTACH FOUR COMESI PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br /> L� GcLITA/-' l d = TR E OF WORK WILL BECOMPLETEDWITHWHETHERSPECIFIEDHERE- 1 <br /> Lor eLocK_oF IN OR NOT,THE GRANTING C�A PERMIT DOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIONAIURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X L,bbtP. <br /> PROJECT ADDRESS APPLICANTS CRY BUSINESS L ICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE FEENO, TYPE OF EQUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND UNITS—H P.EA. <br /> 2 BATHTUB REFRIGERATION UNITS-11.P. EA. <br /> LAVATORY WASH BASINI BOILERS—H.P EA. <br /> SHOWER _ GAS FIRED AC UNITS—TONNAGE EA <br /> KITCHEN SINK!DISP. FORCED AIR SYSTEMS—B.T.0 MEA. 1 <br /> DISHWASHER WALL HEATERS-8.T.U. M <br /> i <br /> LAUNDRYTRAY UNIT HEATERS—B.T.0 M <br /> 1 CLOTHES WASHER EVAPORATIVE COOLERS <br /> I WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN i RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— CFM <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE B CHIMNEY <br /> SINK SERVICE-BAR ETC. WOODSTOVE/FIREPLACE INSERT <br /> BUB TOTAL SUB TOTAL B i <br /> PERMIT { PERMIT ! <br /> _ TOTALFEE ! TOTAL FEE S <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NOMBER PLAN CHECK FEE <br /> FEE RECEIPT NO <br /> USE ZONE LOT AREA VACANT SITE <br /> FFlB VALUATION PER <br /> OYER ONO <br /> TYPE OF CONST OCCUPANCY GROUP NO OF DWELLING UNITS <br /> BUILDING ! <br /> SIZE OF BLDG NO OF STORIES MAX OCL LOAD <br /> PLUMBING <br /> MECHANICAL 1 <br /> FIRE SPRINKLERS REQUIRED ❑YES O NO <br /> OTHER <br /> PENALTY <br /> APPLICATION ACC BY PLANRCHECKED BY APPR FOR ISSUANCE BY - <br /> I <br /> TOTAL { <br /> I <br /> r <br /> { <br /> I <br /> Kr <br />