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� ''r:PPLICATION FO`�'�' <br />'".t".,°'"" CONSTRUCTION <br />cin or <br />everett PE RM IT <br />BUII.DING DEPARTMENT <br />259-8870 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION <br />OV/NER <br />I�n.b ro 51.+�1C <br />PPLNIfF.CT OH �ESIGNER <br />5hn... �e <br />GENEN�LCONiFPGiOH <br />��� �ay <br />MEGNRNICRL,.COINI LTOp <br />PLl1MBIN.CO fPAC10 <br />� <br />CU55OF WORN <br />❑ NEW ❑ ADDITION <br />VASURTION OF KORN �LOST OL M/ <br />PHOJECTRODRE55 <br />PLUMBING <br />NO. <br />❑ COMBINATION �UILDING ❑ MECHANICAL <br />� MAIIAD`�RE^55�ON3%. AN� ST'DRE GitY 21P � <br />'fAn�,��� CoRn• 1 rLR�NNiu9' �Wo /HnJDy CENirE%L 1`� <br />MRIIA oness Cin xir <br />S <br />MRIL <br />MAIL <br />zu� <br />❑ PLUMBING <br />everett <br />e <br />❑ SIGN <br />i 7 390-3y <br />� ��T <br />� UCENSE• <br />�sSN�* 3� <br />LI.ENSE • <br />i �rcucc . <br />ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFiPL.INSERT ❑ Bl11LDING RELOCATION <br />Ofl ITEM <br />WATER.'I.OSET (TOILET) <br />BATHTUB <br />LAVATORY�WASHBASINI <br />SHOWER <br />KITCHEN SINK 8 OISP. <br />D13HWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOGR �HAIN ' <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — FAINLEAOERS <br />SINK (SEFVICE — BAR. ETC.) <br />� <br />nv���consr.9 <br />�fi � ��/� <br />SUBTOTAL <br />PEPMIT <br />fOTALFEE <br />FERR SETBAGN <br />/ <br />LOiAREA <br />c� <br />OCCUPANQGYGFOUP <br />/��� <br />NO.Of SiOP!ES <br />Z <br />BY PUrvSCMECNEDBY <br />. �. <br />I HEftEBY CERYIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIO�J AND KNOW THE SAME TO BE TRUEAND CORRF.CT. ALL <br />PROVISIONS OF LAN'SANU ORDINANCESGOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CUNSTRUCTION <br />OR TI1E PERFORMANCE OF CONSTRUCTION. . / <br />SIGNAiUBEOFCONIFACTOflORAUTHORI2EGAGENT �ATE /2/t��� <br />� / _��� � J�-� <br />5 CIiY <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/C —A/HN�LG UNITS — H.P. <br />REFqIGEf7ATION UNITS — H.P. EA. <br />BOILERS — 9.T.U./h1.F. <br />GAS FIRE� A.C. UNITS — O.T.U. <br />FOFCEO Alq SYSTEMS — B.T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UIJITHEATERS—B.T.U. M <br />EVAPOPATIVE COOIE�iS <br />CLOTHESORYEPS <br />VENTILATIOY FAN <br />HANGEHO00 <br />WA7ER HEA7ER <br />WOOOS70VE <br />METAL FIREPU�CE 8 CHIMNEY <br />fIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%fiAUST FAN <br />:i118 TOTAL <br />I�ERMIT <br />SEtBRCK P�AN GII CK NUMBER FEL � I RE�P� �� <br />- J�-� 1�qa5� �� <br />NO.OF OWELLIN4 UIlITS <br />� <br />� .� <br />�r i.� � � /� - �� <br />s - <br />� <br />� = <br />FEE <br />BUILOING <br />PlUM91NG <br />MEGHANICAL <br />OTHER <br />STATE BUILDING SURCHARGI <br />STA?EENERGVSUFCHARGE <br />PUBUC WORKS <br />TOTAL <br />PROPERN OWNERS ARE RESPONSIBLE FOR OETERMINING ALL <br />PROPENTY LINE LOCATIONSAND RELATED EhSEMENTS. <br />