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;:<; <br />!�'�'PLICATION FOR'-�,� <br />'".E"`°`"" CONSTRUCTION <br />cm oc <br />everett � PERMIT <br />BUILDING DEPARTMENT <br />259•8810 TO BE GOMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COM8INATION O BUILDING ❑ MECHANICAL <br />DWNEfl MAILADORE55 G11V ZIP <br />a4?v��A�fS W22o 1+•£. 21 i�' '13c�1¢vue w�.`C8a <br />�qCHIIEGTORDE51GNEfl MAILADDNE55 CIiY ZIP <br />�.�p 1425 �v�'ST�¢N,�.uf :�'�03 �,�r.ii�c wa.R <br />uENENA;,GONiHFG10N MAILAO�IiE55 C� 21P <br />r�..,�� � �,.�.,.� /.�,�sc 14�a S.w. 124'�'7t'. �s�c4��. `i <br />❑ PLUMBING <br />PHONE <br />���I� <br />1'MONE <br />���� <br />VPONE <br />Zo�, 2 <br />m�oN[ <br />CARS oDE <br />❑ SIGN <br />°lb <br />.�z o <br />LICENSE • <br />, l� 33 <br />lIG[NSE • <br />�RR <br />i irFucF . <br />;USS OF WGflK �,,/ <br />❑ NEW ❑ ADDI710N 10� ALTERATION ❑ fiEPAIR ❑ DC-MOLITION ❑ WOODSTOVElFRPL.INSER7 ❑ BUILDING RELOCATION <br />/�LWTIONOFWORItIGOSTOFMPTERIAL5PLU5LR00R1 ' � <br />'-�Z.Q-99�,-00�. 3 3 , (o d o =% <br />)ESCRIBE W RN <br />REtI,tL �oRG IN'tEY4oR pd.rEK�.T�o�S d- Nt'zv �tr-x5t►.o.rr <br />use ov euaomc <br />5t4ePP�►.�� t��t.�- <br />PLUMBING <br />WATER CLOSET �TOILET� <br />BATHTUB <br />IAVATORY�WASH BASIN <br />SHOWER <br />NITCHEN SINK 6 DISP. <br />URINAL <br />DRINKING FOUNI <br />FLOOR DHAIN <br />BACKFLOW PREV <br />FOOF DRAINS — <br />SINK �SERVICE — <br />'r/ / r � <br />�J.. <br />SI2E OF BlDO. <br />2�Fdo � <br />BELO W OR AIT�GH FOUli C01'IF51.��. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TfiIS AP� <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHEFSPECIFIED HERE� <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEI. THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE Of CONTIiqCTO� 011 AUTNOflIZED AG[NT 04TE <br />Ai'VLICAN f5 CIiV BUSINE55 LICENSE NO <br />� MECHANICAL <br />OR ITEM FEE NO. TlPE OF EOUIPMENT <br />AiC — A/HNDLG UNITS — H.P. <br />fiEFRIGERATIONUNITS—N.P EA. <br />BOILERS — B.T.U./H.P. <br />GAS FIREO A.C. UNITS — B.T.U. <br />FORCED A�P SVSTEMS — B T.U. M <br />WALL HEATERS — B.T.U. M <br />UNITHEATERS—B.T.U. M <br />EVAPORATIVECOOLERS � <br />CLOTNESORVEPS <br />VENTILATION FFN <br />qANGEHOOO <br />� WATER MEATEI7 <br />IS WOOOS70VE <br />METAL FIHEPLACE d CHIMNEV <br />FIREPtACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%MAUST FAtt <br />SUBTOTAL 3 <br />PERMIT i <br />TOTALFEE f <br />RSEIBRC` SIpESE'F <br />FRER VACRNj: <br />oYES 11 <br />VJ ' Z� '�- <br />NO.OFSTONIES M�%.00L.LORD <br />� 7r <br />�VP4G�IION�GC Bv PLPNSGMEGNE06Y <br />� � <br />�3 � 5� CI�CI l QYl <br />�i �'' �1�F� �-�{.����� �- � <br />�PPq. FOfl ISSU�NGE BY <br />' 1� <br />ree <br />SUBTOTAL <br />PEflMIT <br />� TOTAI FEE 7� <br />P�L7AN� CH C/K� N�UMfBER�-+' FEE, / FECEIPT NO. <br />CJ� v�/VU ' [�I���r <br />FEES VALUAT,I�ON FE� <br />Bl1ILO1NG S ��.In/ V 1 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STA7E BUIL�ING SURCHARGE <br />STATEENERGYSURCMARGE � <br />PUBLIC WORKS <br />TOTAL <br />PROPERN OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONSANO RELATED EASEMENT . <br />