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�;PPLICATION FOK� <br /> . '"'E"'°'"" CONSTRUCTION �`e <br /> CItV Oi <br />� everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•eStO TO BE COMPLETED IN INK• PLEASE PRINT <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> ��A n A ` �50�1�O.��,��tro 9 C'e+C d�c 1 C����� ,��c �.�i�.k�r .�+rsa��c���� <br /> �RGNItECI DH DLS�ONE/� � M�II�DOPC55 G4Y 210 PHONC <br /> OENEA�LCONin�CtO� MAR�p0�E5S Clrv r� I �/� }�i <br /> �— i�v ��E ��J�J���I I"I�UIV17L�J�II� <br /> �l lG_{\L (�,(�`_� ECJl1tP. �(�• , I�Q�J l� I T1Q,16110 �)ZQt.I� �I?. ti r l�l ' <br /> MELH�NIC�I LONiR�LfOq MAq sO�RCS GfY liCi pHONE IICCNSE• L' <br /> PLVMBINOCON1RApipq M�II�ODRE93 CIfY IIP PIIONE IICENSC• <br /> C1�53Of WORIt <br /> ❑ NEW ❑ AODITION �ALTEfiATION ❑ i7EPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.tNSERT ❑ BUILDING RELOCAIION <br /> v�w•non or woa�icosi or Merenuie nws ueom <br /> i <br /> DEfiCRIBE WORN <br /> � i�� � ►-1 I e�rnvn�C��k. -c,�1'�l�e►v I�cCt.to) <br /> U6EOfBUitDiHG � <br /> 2 i �� �p� I HEi7E8Y CERTIFV THAT I NAVE READ AND E';AMINED THIS AP• <br /> U�� PLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.All <br /> LEOIILOESCF�Pf10NO�PPOPERTV�SHOWNBEIOWOR�fi�CNfW�COPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � OF WORK WILL BE COMPIETED WITH WHETHER SPEGFIED HERE <br /> �oi—e�oc�—o� IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PR[SUME TO <br /> . GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROJISIONS OF" <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> � — OR THE PE�FORMANCE OF CONSiRUCTION. <br /> SIGN�iURG O�CONIq4QOP OR qViHOf112ED�GENT pAT[ <br /> X �:t�1��C r�c���-�� l ,� g,, <br /> PNOJECT�ODRE55 �PP�IC�NfS C�fY 9U5 W E SS IiCE NSF. <br /> � SRf�Q.., lt�5 fl�U'E. <br />� � <br />� KUMSINO MECHANICAL <br /> NO. T'PE OP fl1ITU11E OII ITEM FEE NO. TYPE OF EOUIVMENT FEE <br /> WATER CLOSET�TOILET� A/C—A/MNDLO UNITS—M P. <br /> � BIITMTUO REFRIGERATIONUNITS—l1.P.EA. <br />� . UVATORY(W�SH91151N) BOILERS—B.i.U./HP. <br />� SHOWER ap5F1REDAC.UNITS—B.T.U. <br /> � KITCHEN SINK 6 DISP. FOi10ED�IR SYSTEMS—BS.U. M EA. <br />{ DISHWASHER Wn�.HEA7ERS—BTL. M <br /> I � ' UUNDRY TRI1Y UNIT HEATERS—BS.0 M <br /> II � CIOTHESWASMER EV�POR�TIVECOOLERS <br /> I 'i URIN�L CIOiHE50FVER5 <br /> DNINKING FOUNTAIN VENTILATION FAN <br /> FIOOR DRAIN qpNGE NOOD � <br /> BACKFLOW i'REVENTERS � WATER HEATER /gO QLU (j7Y,( <br />'�' ROOFONAINS—R�INLEADERS WOODSTOVE '� <br /> I` SINK�SERVICE—B�R.ETC.) METAL FIREPLACE 6 CHIMNEY <br /> PIREPLACE INSEfiT <br /> Ik � HEAT PUMP <br /> I�I � � GASPIPING <br /> II ' E%NAUSTFIN <br /> fU!TOT.1L f SUS TOTAL <br />'� PEPNIT ! PERMIT <br /> i <br /> TOTAIFEE f TOT�LFEE <br /> FPONi SElB�Ct PE�R 8E10�CK S�DE SETB�CK RAN CMECK NUMBER FEE RELEIPT NO. <br /> I <br />�� <br />`I' UBELONE LOiAPEA y��ANi51iE FEES VALUATON FEE <br /> i OYES oN0 <br />�� BUILDING S <br />� TVPEOfCON9t. OCpUP�NLYGROUF HO.OFOWELLINOUNIiS <br /> I <br />�.j PLUMBING <br />�� 512E Of B�DO NO OF SiORIEB MeN OGC �OAD <br /> I MECNANICAI <br />.� <br />`+ OTHER <br />;i FlFE SPRINNLE(iS REOUIREO ❑VES O NO STATE BUILDINa SURCHARGE <br />'� _ STATEENEHGYSUNCHnFGE <br /> �PPI�C�IIDN�CGBY P��N9CHECNEOBY �FPR.FORISSII�NCEBY <br />� PUBLIC WORKS <br /> I 10TAL <br />� PROPERTV OWNERS ARE RESPONSIBLE FOR�E7ERIAINING ALL <br /> PROPERTV LINE LOCATIONS AND REV.7ED EASEMENTS <br />