Laserfiche WebLink
EA.E»mPF.R APPLICATION Fu1R ;L.,, <br /> OTY OF CONSTRUCTION <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br /> BUILDING DEPT. <br /> 258.8745 [ ] COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER / 'V GFTT FNTa.N MAIL AODRESS CITY ZIP PHONE <br /> 9Fzrri fS3-// 77 <br /> AFICH,TECT OR DESIGNER MAILADURESS Cott ZIP PHONE <br /> I �..Lelt/'-3. . _ 7. 2211 ars 3zot� <br /> S1 <br /> GENERAL CONTRACTOR MAIL ADDRESS Cltt ZIP PHONE LICENSE• <br /> e�~ T �'�' /3'I A? A .�✓.-v E✓/�7Mf' 9F3+�f 3r)-/r 77 �.J& <br /> (I MECHANICAL CONTRACTOR MAIL ADDRESS Cltt ZIP PHONE LICENSE I, <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> CLA990F WORN <br /> �S NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVC/FRPL.INSERT ❑ 13UILDING RELOCATION <br /> VALUATION <br /> OF WORK(C�OIST�O)F MATERIALS PLUS LABORI <br /> T7 y V <br /> DESCRIBE WO K <br /> F <br /> USE OF BUXOING . <br /> iJ� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> �( PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY I SHOWN BELOW OR ATTACH FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT-BLOCK_OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME 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 AUTHORIZED AOENT' DATE <br /> PROJECT ADDRESS APPLItANTS CITY BUSINESS LICENSE NO <br /> l0 3 7 7TH P[. 3i.►. S.Lu <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) CD I AIR COND.UNITS-H.P.EA <br /> BATHTUB 4 601 REFRIGERATION UNITS-H.P.EA <br /> LAVATORY WASH BASIN BOILERS-H.P.EA <br /> SHOWER GAS FIRED A.C.UNITS-TONNAGE EA _ <br /> KITCHEN SINK&DISP. q0L FORCED AIR SYSTEMS-B.T.U. MEA _ <br /> DISHWASHER WALL HEATERS-BT.U. M _ <br /> LAUNDRY TRAY UNIT HEATERS-B.T.U. M <br /> III CLOTHES WASHER 40z EVAPORATIVE COOLERS _ <br /> WATER HEATER G T CLOTHES DRYERS Sb <br /> URINAL VENTILATION FAN OD <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT- C.F.M. _ <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS-RAINLEADERS METAL FIREPLACE&CHIMNEY <br /> SINK SERVICE-BAR ETC. WOODSTOVHFIREPLACE INSERT <br /> SUBTOTAL O SUB TOTAL f <br /> PERMIT f PERMIT • <br /> TOTAL FEE • TOTAL FEE • OV <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> i CHECKFEE <br /> FRONT SETBACK REAR SETBACK SIDE SFjTBAGN PLANCHE /�� �O NIGER FEE ,7x fj" NRECEIPT NO qD` <br /> 1. <br /> USEZON LOT AREA , M 8 ONO FEES VALUATION FEE <br /> r <br /> TYPE =4ST OCCUPANCYGROUP NO.OF DIY LLINO UNITS <br /> BUILDING fd. 02 tog sc) <br /> SIZE OF BLDG NO.OF STORIES MAX OCC.L AO <br /> PLUMBING <br /> E�//77FEPF <br /> FIRE SPRINKLERS REQUIRED O YES F'NO MECHANICAL— OTHER <br /> f <br /> APPLICATION ACC BY PLANS CHECKED BY APPR FOR ISSUANCE By PENALTY <br /> TOTAL <br /> L . c_ <br />