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IM Err�OrMn <br />pN Of <br />everett <br />BUILDINO DEPARTMENT <br />259•8B 10 <br />A('tirLICATlO O � <br />CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION Qi BUILDING O MECHANICAL ❑ PLUMBING ❑ SI(iN � <br />OWNfII M�IL�ODRE86 :IIY 2�P PNONE ' ' <br />Ri1��" OrtTFIweS7fo�vsTl�� �T.���"� Z� FHONE <br />•RCNItEG��`:!Ok]�ONER M�R�D08E68 <br />ti An�r 2 72f -1 1(, ST S r C �r'rztr7. uA. . 9&�za� 337-7�.�3 �tMTpuveL <br />OlNERSLtONIa�GtO� M�IL�ODPFDS CIfY ZIP OPOVE L�CEXS[• <br />9AM � <br />�, �, •r `� " <br />MECH�N�WLCONtMCiOq MML�DDRElS CIfY 21P FIIDNE IIGENSE• <br />PWM�INOCONIP�LiOA M�R�DD�E9S C��Y IiP PIIOHE LICENSE• <br />,� e��Eyyon�[] AQDITION ❑ ALiERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL.INSERT ❑ BUILOINO RELOCAiION <br />_ ___ ..__...�.��.���.��en.��en111�11R(]PI <br />S <br />to�— <br />(o�f, �FSz- <br />PROJEGI�O�RE59 <br />r[y 15 � <br />PLUMBINO <br />NO. TYPE OF FI%TURE OR I <br />W�TER CLOSET 1T01LET1 <br />B��MTUB <br />UVA70NY IWASN B�SIN� <br />SNOWER <br />� KITCMEN SINK 6 DISP. <br />� DISMWASHER <br />UUNORY TR�Y � <br />CLOTHES WASHER <br />UR�NAL <br />DRINKINO FOUNTAIN <br />FLOOR DR�IN <br />BACNFLOW PRE�ENiERS <br />ROOF DRpINS — A�INLEADERS <br />S�NK (SERVICE — BAR. EiC) <br />SUBiOTAL <br />�HOl1� f,R � P[�R <br />1 <br />WEL(�'1� LOf/ <br />C — � � <br />IION�CC B• <br />1 ' 1" <br />! <br />f <br />f <br />SIDE 8E1tl�GN <br />V�G�Ni SIIE <br />O �YE9 ONO <br />_�� <br />NO OF SIOPIE9 M�%.00G IOAD <br />� <br />BY <br />�� <br />155UANGE <br />� <br />I NEREBV CERTIFV ?HAT I HAVE READ AND E%AMINED THIS AP• <br />PUCATION ANU KNOW THE SAMETO BE TFlUE AND CORRECT. ALL <br />PqOVISIONS OF LAWS AND OROINANCES30VERNINO THISTYPE <br />OF WORK WIIL BECOMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTINO OF A PERMIT DOES NOi PPESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STA7E OR LOCAL LAW REOULATINO CONSiRUCTION <br />OR TIiE PERFORMANCE OF CONSifiUCTION. . <br />910N�lUREOfCONiR�C70RO�AUfNOR12EDAGENT O�IE <br />x �r..l���p��-� �' �-z �-�-9 <br />� ---_.._..---....__.._ <br />0 2 �.'i <br />MECHANICAL <br />TYPE OF EOUIPI <br />A/C — A/NNDLO UNIiS — H.P. <br />REFRIGERIITION UNI15 — H P. I <br />BOILERS — O,T,U./N P. <br />O�S FIRED A.C. UNITS — B.T.U. <br />FORCED 111R SYSTEM9 — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEAiERS — B.T.U. <br />EVAPOF�TIVE COOlEi1S <br />CLOTNESDRYEPS <br />VENTILATION FAN <br />RAN(:ENOOD <br />WA7ER MEATER SO� <br />WOOD ST��E 7 <br />METAL FIFEPUCE 6 CHIMNEY <br />FIl1EPV�CE INSERT <br />NEATPUMP <br />GAS PIPINO <br />E%HAUSTFAN _ <br />M EA. <br />M <br />M <br />!UB TOTAL <br />P[RMIf <br />TOTALFEE <br />PLANCMECH 1MBER FEE <br />� � %a i 5�� �a� � <br />BUILOING �yy� XY� I 5 <br />PLUMBING ' � � � ' <br />MECHANICAL <br />OiHER <br />STATE BUILDING SURCHAR6 <br />STATE ENERGY SURCIiARGE <br />PUULIC WORK9 <br />TOTAL <br />PECEIPT NO. <br />I`��V <br />PROPERTY OWNEf75 �RE RESPONSIBLE FOR DETENMININO ALL <br />PROPERN LINE LOCA710N5 AND RELA7 ED EASEMENT3, <br />