Laserfiche WebLink
r '?PLICATION FOk <br />cln of <br />'°'EY..,...° CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE_ PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING _SIGN V <br />OWNER <br />�� MAIL AOURESS �h CITY ZIP <br />PHONE <br />ARCHITECT OR MEr� 21P�� PHONE <br />GENERAL CONTRACTOR MAILADURESS CITY ZIP PHONE LICENSE <br />JR Act sTm�/wacl <br />+ni F-04-v4zi Tzn•[311mS <br />M'•:I AN�CA: CO CFACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />PLUMBING CONTPACTOR MAILADORESS CITY ZIP PHONE LICENSE..• <br />CLASS WORK <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ %v Or)DSTOVE/FRPL.INSERT ❑ BUILDING RELC'JATION <br />VALLI ION OF WORK(COBT OF MATERIALS PLUS LABOR) _— <br />s <br />rn[S7ilit_ Tu-uMW/kTu� A-j-3&);o no `ru-,o akw- Ar 'Lyos <br />USEOFBUILDINO _ ��� <br />CL!/1(lC� y-r /.-,0%Ac nc <br />%_ <br />I HEREBY CERTIFY THAT I HAVE REAE AND EXAMINED THIS AP- <br />cLiCATION AND KNOW THE SAME TO BETRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NO''. THE GRANTING OFA 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 TRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERn(SHOWN BELOW OR ATTACH FOUR C PIES) <br />LOT _BLOCK --OF <br />PROJECTADDRESS <br />APPLICANTS CITY f4NNESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />-E <br />WATER CLOSET TOILET) <br />I <br />AIR COND. UNITS-H.P. EA. <br />BATHTUB <br />REFRIGERATION UNITS-H.- EA <br />LAVATORY WASH BASIN) <br />BOILERS-H.P. EA <br />' <br />SHOWER <br />GAS FIRED A.C. UNITS-TO'INAGE EA <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRY TRAY <br />UNITHEATERS--B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />_ <br />WATER HEATER <br />CLOTHES DRYERS <br />J <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF URAINS-RAINLEADERS <br />_ <br />FIREPLACE A CHIMNEY <br />SINK SERVICE -BAH, ETC.) <br />_METAL <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUBTOTAL 3 <br />PERMIT 3 <br />PERMIT_ $ <br />TOTALFEE $ <br />TOTAL FEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACKSIDE SETBACK �- PLAN CHECK NUMSER PLAN CHECK FEC <br />FEE IR:CEIPT NO. <br />LOTAREA VACANT SITE <br />+' OYES ONO FEES VALUATION FEE <br />.ONST. I OCCUPANCY GROUP I NO. OF DWELLING UNITS <br />SIIE OF BL]G I NC'. OF STORIES I MAX <br />BUILDING is I <br />PLUMBING <br />ME. HANICAL <br />OTHEP <br />PENALLY <br />TOTAL <br />