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C';��; <br />tiPPLICATION FO1. ' <br />'°'E""°'"° CONSTRUCTION <br />CITY OF <br />eve�ett PERMIT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION O COMBINATION 0 BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />everett <br />� <br />❑ SIGN <br />owHen M,a.o��.��� ..,�, ��� .,w,.� <br />/�G�lr/G�3T ,G/.tJi1,�Jc-/AL ��U[i /�171 GsUGrh'!� trJ�f 9�ad6 aS9-727L <br />FFCIIItEGt011DE5iG��EN MAILRDORESS CpY 21P PHONE <br />4 •� <br />GENE M� UNE55 � [.� ` ZIP n� LICENSE • <br />�T F/�ANEr�"� . -- • - - , .,. ._ __ �!-7L��_ . <br />Mee��eoHrnncr�n /.S G^M'��f+qak�/HL' /�VG7FC�TT01TM�f��U/ zir r��oNe ueeNse• <br />PLUMBiNGCONIRAGIO� MAILAODRESS CIPI 21V PIIONE IICEHSE• <br />❑ NEW ❑ AD�ITION l'J ALTERATION ❑ FEPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />/�lllAl ON OF WORN�COSi Of 1.IAIENRLS PLU9 LROON <br />�/ �I, S od <br />/�UTE-X'IUP, �F oF�-iofr iN �� <br />USE Oi pUIIDING <br />�/-� l�4r <br />IEGRI �ESGRIPIION OF PI <br />�o�—ewc�— <br />PPOJECi <br />PLUMBING <br />NO. TYPE OF FIXTL <br />WATEH CLOSET �TOILET) <br />BATHTUB <br />LAVATORY�WASM 9ASIN� <br />KITCHEN SINK 6 DISP. <br />UIUNORYTRAV <br />CLOTHES wASHEP <br />11P.INAI �., �/� <br />SINK <br />FRONISEIO�CN <br />USE ZONnE <br />` �/ <br />,!%L-N <br />)F 8�00 <br />//y � <br />;AiIONnCG OV <br />�� ` <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />R SETBACK <br />ARER <br />:UPQANGYGBO <br />/,;J ' 2 <br />or sronies <br />i <br />FOUR COPiES� <br />FEE <br />VpCANT 51IE <br />❑YES ONO <br />N0. OF 0\VFL�INa llNliS <br />� <br />iy <br />�� � G.G. <br />OY <br />I HEREBY CERTIFY THAT t HAVE READ AND EXAMINED THIS AP� I <br />PLICATION AND KNOW THE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <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 PROVISIOPlS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOh <br />OF THE PE FlORMANCE OF CONSTRUCTION. <br />SIGNAIURL FCdN1i1ACTGR OR A}�THORIZED AGENT D4TE <br />i� � /n N _.. / i-�� �_n <br />QC9 <br />MECHANICAL <br />NC - A�HNDLG UNITS - H.P. <br />REFRIGERATION UNITS - H.P. E <br />BOILERS - B.T.U.MP. <br />GAS FIRED A.C. UNITS - B.T.U. <br />FORCED AIR SYSTEMS - B.T.U. <br />WALL HEATEPS - B.T.U. <br />UNIT HEATERS - B.T.U. <br />EVAPORATIVE COOLE(i5 <br />CLOTHESORVERS � <br />WATETiHEATEii � � V/ <br />WOODSTOVE �T— <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%NAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />PLANCHE KNUMBEH FEE <br />�7 4283 la <br />FEES <br />BUILD�NG <br />PLUMBING <br />MECHANICAL <br />OiHER <br />STATE BUILDING SURCHARG <br />STATEENERGVSURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />$I <br />M EA. <br />M <br />M <br />FEE <br />RECEIPT NO. <br />� ���2 <br />FEE <br />PROPERTV OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTV LINE LOCATIONS AND RELATED EASEMENTS. <br />