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r <br />� <br />� <br />� <br />m. enryr..n <br />ciTr or <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />';'yPPLICATION FO�'�� <br />CONSTRUCTION <br />PERM�T <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />�DEMOL�TION ❑ COMBINATION <br />❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />Clry PIIpNC <br />`� / ZIP <br />� �,�Ji n«ClChe-.� ����'r7Sr-f>�3i� J �✓-�'iz>� <br />GFNEMLGONiReL10R AV.IL��OOE55 �i�� IIP (+bOHE LI�ENSE• ' <br />_%'l�l��'r c' �� P <br />Muienoqess <br />ziv <br />.••"••� LR:CIiSf I <br />PWMBINO[pNIR�LiOR MAi��00HE55 CIIY I�P PIIONF LICENSE• <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR I� DF.MOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�IU/1TION Of WpqK �COSf Of M�IEHulS C W 5 L�lIONI <br />!j1 :7.oii _3n' �o ' s��;c.�` �plL b /i <br />�o,na � <br />r <br />Lo7`s iS �/6 <br />k �5`d / �r� <br />PLUMBING <br />NO. TYPE OF FI)ITURI <br />WATER CLOSET (TOILET) <br />BATMTUB <br />LAVATORY�WASNBASIN� <br />SMOwER <br />KITCMEN SINK A UISP. <br />OISMWASHER <br />' UUNDRYTNAY <br />CIOTFIE3 WASMER <br />UHINAL <br />DflINKlhO FOUNfAIN <br />FLOOR ORAIN � <br />ROOF OPAINS — q�IN�EADERS <br />SINK �ScRVILE — BAR. ETC.) <br />SUBTOTAI <br />PEHMIT <br />TOTALfEE <br />3.1Ctl PE�RSEiB�CN <br />LOTApE� <br />VL�H9 <br />WC�NI SiiE <br />❑YES []NO <br />No or owei <br />FOR <br />�o�o <br />5 <br />i HEREBY CERTIFY T AT I HAVE READ AND [XAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORpECT. ALL <br />PROVISIONS OF LqWS AND ORDINANCES GOVEqNING THIS TYPE <br />OF WORK WILL BE COMPLETED WIThi WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE �1UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />AN V OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION <br />OR THE PEFFORMANCE OF CONSTqUCTION. . <br />516NR1�)FEOF�ONiFACIORORpUTHOlIIIEDAGEN pAIE <br />�� .l�l �l��lC�% <?.S- � <br />MECHANICAL <br />7YPE OF EOU�PMEN7 <br />A/C — A/HNDLG UNITS — H P. <br />REFflIGERqTION ��NITS —M P. EA. <br />BOILERS — B.T.U.M.P. <br />GAS FINEO R.C. UNITS — B.T.U. <br />FORCEDAIqSYSTEMS—BT.U. M <br />WALLHEAfERS—B.T.U. M <br />UNITHEATERS—B.T.U. M <br />HOOD <br />wOODSTOVE ' <br />METAL FIREPUCE 6 <br />FIREPUICEINSEAT <br />PLAN CMECK NUMBER <br />8UBTOTA4 <br />IKPYIi <br />TOTAL FEE <br />I FEE <br />BUILDING 5 <br />r�uueiNc <br />MECMANi�AL <br />OTHER <br />S7ATE BUIL�ING SURCHAqGE <br />STATEENERG�SUFCMARGE <br />PUBLIC WORNS <br />TOTAL <br />RECEIPT NO. <br />PROPEFTY OWNERS ARE RESPONSIDLE FOR DETERIAININO ALL <br />PROPENN LINE LOCATIONSAND RELATED EASEMENTS. <br />