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9yy <br />n <br />DH <br />VI <br />xy rti <br />t*1 U <br />OH <br />;d a 8 <br />t qd <br />HH <br />H <br />O ey CG <br />Pp <br />HVEED <br />!li <br />Ii _'IIPPLICATION Qk`#� <br />[BF OFEr„n CONSTRUCTION' <br />CITY OF <br />.11 <br />everett PERMIT <br />L <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />LI PLUMB114G <br />❑ SIC N <br />OWIER MAIL AOD9ESP CITY ZIP <br />PITON[. <br />- <br />�C7RtS� 'Dpoa\'-zi, t&\3 3Qv_4uft 5•1Elit <br />°t8704 155S-1a3 <br />+acNlTF141�Or1�ELn NESS CITY <br />aAYOto :��*�G�t!%54-' <br />"do ) <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE <br />LICENSE <br />� /'yB <br />& <br />MECHANICAL CONTRLCTOR MAIL ADDRESS CITY ZIP <br />PHOIIE <br />LICENSE• <br />PI.IMRINGCON-FACTOR MAIL ADDRESS CITY ZIP <br />PI4ONE <br />LICENSE• <br />LASS Of WORK <br />-*NEW ❑ ADDITION ❑ ALTEFATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION E WORK [COST OF MATERIALS PLUS LIMEM �� <br />�, l.rr�� 7- . E7E/1F-fZ AT=Iy1V1 <br />1&msvyeo-� <br />USE Of BOLDING <br />�� EE(AL.. ..,� ���� <br />4►IkKA � <br />1 HEREBY CERTIFY THAT I IIAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV13IONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL 3E. COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GI VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />NljO,F CONTOA�1OfaR A/LITHAll ORIZFD AGENT DATE r/Llit- <br />x <br />! <br />I. EOAL OESCIPTION Or PROPERTYrSHOWN BELOW OR ATTACH FOUR COMES • <br />,� - l !. <br />lyI_BEoeK_or <br />,•',� ; : <br />�` to IV 5It -'-i - <br />--- <br />PROJECT ADDRESS <br />15p!!N CJ�`% �t S • G <br />APPLICANTS C.�IN 9SOCLENSE NU <br />_ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />_ <br />FEE <br />WATER CLOSET TUILETI <br />AIR COND UNITS-H P. EA <br />BATHTUB <br />REFRIGERATION UNITS-M.P. EA <br />LAVATUHY IWASH BASINI <br />ter <br />BOILERS-H. P. EA <br />SHOWER <br />GAS FIRED TIC. UNITS -TONNAGE EA <br />KITCHEN SINK E DISP. <br />U <br />FORCED AIR SYSTEMS-B.T U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />_ <br />7a <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHESORYEFS <br />URINAL <br />_ <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CVIA <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAMLEADERS <br />4F <br />METAL FIREPLACE 6 CHIMNEY <br />- <br />- _ <br />SINK SERVICE -BAR ETC. <br />WOODST VEIFIR PLACE INSERT <br />a <br />_ <br />a <br />{ <br />I-- <br />- <br />SUB TOTAL <br />PERMIT B <br />TOTALfEE E <br />BUD TOTAL _ <br />PERMIT _ IT <br />TOTALFF.E <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />I PONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECR NUMBER <br />ti7 r_l� f y r,`-� •� <br />I 1 <br />PLANCHELKFEE <br />FEE j` �I" Lrl <br />^_ l <br />RECEIPT NOW T/ i'`7 <br />ice' E <br />I Cd ZONE <br />LOT nRU <br />VACANT SITE <br />ES ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONS <br />:r- ',A/' <br />OCCUPANCY CROUP <br />` PA' 3 <br />NO OF DWELLING UNITS <br />BUILDING <br />Q <br />SIZE OF BLDG <br />NO Cl STORIES <br />„_ <br />MAX OCC LOAD <br />IV. AA <br />PIUMBINO <br />C <br />FIRE SPRINKLERS REQUIRED ❑ YES "0 <br />MECHANICAL <br />OTHER <br />T <br />PENALTY <br />IIPLICATION ACC BY <br />I� (M <br />PLANSCHECKEDBY <br />/Y <br />APPR For ISSUANCE BY <br />L G , <br />TOTAL <br />I� <br />C <br />7 <br />