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ti 04.,'PLICATION FOR <br />the EOFFpn�rt CITY of CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION 11 BUILDING O MECHANICAL ❑ PLUMBING <br />ItiE1M U I E.I Z 1 (l '5 /(I "AvL-Sc FyCW0-7 _ <br />ARCIIIECIOR IIESIGNER MAIL ADORE SS CITY III` 1410N1 <br />IGN <br />GENERAL CONIRACI00 <br />MAIL ADDRESS CITY <br />IIP <br />PUONf. <br />LICENSE <br />geytP" /!lCnn! INC. <br />/-',0. 8'6x `:26ri 4Y4Rw.J vrl ���. <br />J.favb <br />S <br />7 �' 35' <br />&5lWtlN'kN7z:4g <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CNY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CCNIRACIOn <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />LICENSE• <br />❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />1AL iION OF WORK ICOSI OF A1AiENA1.3 PLUS LABOR) <br />DO' <br />OY 9 <br />DESCRIBE Won <br />ADO (n I k Q/ Olio it u,T.40,14.70 S/6.4,' '7a &iS,7,.vG �CCAr <br />USE OF BUILDING <br />CU L�1U)zZC• <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMITDOES NOTPRESUME 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 />SIGNA 7UE F CONTRACTOR ORlJ.ITHORIZ D AGENT DATE p <br />APPLICANTS CITY BUSINESS LICENSE ❑0. <br />'331s�, <br />Lt GAL DESCRIPI ION OF PROPERTY ISHOWN BELOPI ON AT TACIT rOUn COPIES, <br />LOT_BLOCK —_OF <br />PROIFCT ADDRESS <br />95 o5- AVE6,- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />_ <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND.RIGER UNITS-H.P. EA. <br />- <br />BATHTUB <br />REFRIGERATION UNITS-H. P. EA. <br />LAVATORY(WASHBASIN) <br />_ <br />BOILERS-II.P. EA.__ <br />— <br />SHOWER <br />_ <br />GAS FIRED AC. UNITS -TONNAGE EA <br />_ <br />KITCHEN SINK 8 DISP. <br />_ <br />_ <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />_ <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE -BAR, ETC.) <br />WOODSIOVE/FIREPLACE INSERT <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />__. <br />.__�._...__._ PERMIT _.______ S <br />_—_ _ <br />..- _. TOTAL FEE._ .. .. $ <br />_ <br />_ <br />TOTAL FEE __— 6 <br />THIS PORTION TO <br />BE COMPLETED BY BUILDING <br />DEPT. <br />PERSONNEL <br />SETBACK <br />READ SETBACK <br />SIDE SET BACK <br />PLAN CIIECN NIIAIBF.R <br />PLAN CIIH;K <br />USE tUNE LOT AREA I VACANT SITE <br />-I ❑YES NNO <br />TYPE OP CORSI. I OCCUPANCY GROUP I NO OF DWELLING UNI IS <br />MAX. OCC. LOAD <br />ICANON ACC BY I PI ANS C NECKI'D BY <br />e;: �l <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER ^ — <br />PENAI lY <br />TOTAL <br />FEE I RECOPT N0. <br />FEES VALUATION I FEE <br />E <br />6 <br />