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�.`:'„ ,,• <br /> APPLICA�'ION FOR �OMSTRUCTION <br /> PERMIT <br /> I�e Er�ryresn rverelt <br /> GTY OF <br /> � everett e <br /> BUILDIN3 DEPARTMENT <br /> 259•eeto 40 BE COMPLETED IN INK— PLEASE.PRINT <br /> OWNEH MAIUDDPESS C�IY tiV PnONE <br /> TEN�NT M�IIA�OPE34 GttY Tlv p11pNE <br /> �i.r,.,v . .��,,.�rsson 3�0/�_�o/� cf�t�- �UCre�' ���o� a--`�^�-�/37� <br /> MICN�TEGiORDES� NEN MMt/�DUFE45 CItT L�V PHDNE <br /> OEMEA�LCOMiH�CiOF M�ILAD�RESS GTY ZIP R10NE UGEHSE• <br /> MECM�NIC�LCONTRAGTO� MAILADDHESS QTY ZIP PNONE L�CENSE• <br /> PLUMBIMO CONTPNGTOA M��t�ODBEB! pTY llP 1`NOHE 4CEN9E• <br /> QAlB O�N9H1t � <br /> ❑ t1EW ❑ AODITION ❑ ALTEMTION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVFJ1f.PLINSERT ❑ 6UILDINGRELOC�TION <br /> iEMIJ1T MPIqVEMENT OP IMERqR REMOUEL ONLY CONUCT PERWN�NO PXONE NO. <br /> OOMTRACI P1110E Oi WORI( <br /> pEDCRME W0111(�ND 60U�RE FOOiME IHVOLVED <br /> vnovosEo Us¢or euno�Ho 1 HEREBV CERTIFY THAT I HAVE READ AND E%AM�NED THIS APPLICATION AND <br /> KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS Of IAWS ANO <br /> IEWL OEBCN�VOON(K�OPEHiY16HOWN BELOW OH�TT�CM FOURCOPIEH ORDINANCES GOVERNING TNIS 7YPE OF WORK V/ILL BE COMPLETED W!TH <br /> W H ETH ER SP ECIFI ED H EREIN OP NOT.TN E GRAN TING OF A PERMIT DOES NOT <br /> PRESUME TO GNE AUTHGRIN TO\90L/dE OR CANCEL TNE PROViSIONS OF <br /> �m �aK oF ANYOTMERSTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER <br /> FORMANCE Uf CONSTRUCTION.iNAT 1 AM AUTHORILED BV THE OWNER OF <br /> 7NI5 PROPERTY TO PEFI'ORM THE WORK FOR WHICH�PPUGAiION 19 MADE <br /> AND I COMPLY WIiH THE STATE CONTFACTORS LAW 78.27 NCW �ND <br /> 298.200 WRG <br /> b�ON�iUREOFCONfR�C10ROR�Ui110RRED�GCNi O�TE <br /> X <br /> �'�C��R�9 WPLIGJITB GiV BUSINESS UGENSE NO I1N0 BUSINE39 N�ME <br /> ►IUMSIN6 � MECHAN�CAL <br /> Np, TY:'E OF FI%TURE OR�TEM FEE N0. TYCE OF EOUIPMENT FEE <br /> WATFR CLOSET(TOILE'i) NC—NHNDLG UNI75—H.P. <br /> BATHTUB FORCED AIR SVSTEM9—B.T.U. M E0. <br /> LAVATORV(WASHBA3IN) UNITHEATERS—BT.U. M <br /> 9HOWF.R CLOTHES DRYERS <br /> KlTCNEN SINK 6 DISP. VENiILATION FAN <br /> DI6HW�SHER RANGE HOOD <br /> � LAUNDRVTRAV WATER HEATEF <br /> CLOTME9 WASHER WOOD STOVE � _ <br /> URiNAI METAL FIREPLACE 8 CHIMNEY <br /> DRINKINO FOUNTAIN FiREPLAC[INSGfiT <br /> FLOOH DRAIN HEAT PUMP <br /> BACKFLOW PREVENTER9 GAS PIPING <br /> ROOF DRAIN9—RAINLEADERS EXNAL`Si FAN <br /> GINK�6ERJ:CE—BAR,ETC.) _ <br /> SUBTOTAL S SUBTOTAI S <br /> PERMIT S PERMIT S <br /> TOTAL PEE S TOTPL FEE S <br /> i1qHT8EiBl�C1( f121R9ET8�GK SIDEBETBGGN PUMCNECNNUMBEP fEE �ECEIPfMO. <br /> � ueEZoxE IOUPFA wCu+ru�rc FEES VALUATION FEE <br /> o rEs o No <br /> TYPEpFCpNST. OCCU��NCYaROUP NOAFDWELLINOUMTB BUILDING _ __ <br /> N'���8����� PLUMBINO <br /> lREOFBLOO. NOOF610RIE8 B9ML IX,GII'W <br /> o Y MECHANICAI <br /> ❑N — — <br /> MEIONTLIMITI�l10N OTHER <br /> ' _ <br /> FlRESPRiNKLERdREOVIHEO p'/f9 oNo GRiEBUILDINGSUf�CHARGE <br /> � STAiE EHCRGY'URCHAAGE <br /> �PR!G110N ACG BY PIANH�PPR BT <br /> PUBLIC WORKS <br /> TOTAL <br />