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/ <br />"''���PPLICATION FO�°�� <br />.�. <br />,".E""°'"" CO(dSTRUCTfON <br />cin oF <br />everett PERMlT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION �COMBINATION ❑ BUILDING L[SMECHANICAL ,�PLUMBING <br />wuco MRILRD�RE55 CI1Y ZIP PHONE <br />�,t-�2 va� SrAvu�rs � <br />�NGHITECTORDESiGNER MRIIFDDNE55 C�tY ZIP PNONE <br />-�'iLHil <br />GENEMLCONTR�GtOP MMLAODflE55 CItV tiP PHONE UCENSE• <br />�c„� zw� • u�+�U�Mc �sa8� <br />MELH�NIC�LCONTH�CTOq M�IL�OONE55 CIiY ZIP PHONE l'CENSE• <br />AlA20.Jn�� i'YlEtr}d,�iede� Pn�� F�FS' �Dnrowos �u�t �i8'v2o ��6-Gzoo %Q�— <br />PLUMBiNG LONiRACiOR MAII RODBE55 CIIY 21P PIIONE 4CENSE • <br />� �/ ✓ �/ �/ <br />V ' <br />GL�SS OF WOR1( <br />� NEW� '❑ ADDITION ❑ ALTERATION ❑ REPA�q ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BU�LDING RELOCATION <br />�nnvn� <br />WONK <br />PROJECTApUFE55 <br />/`iz1= 5[= �'U��ZE.7T /+��t t_ C�JA <br />PLUMBING <br />WATER CLOSET �TO�LET) <br />BATHTUB <br />UVATORY �WASM BASIN� <br />SHOWER <br />KITCHEN CINN E DISP. <br />OLDO <br />� <br />� <br />SUO <br />TOTALFEE <br />SEiB�CK ISI�ESETBeGK <br />LOi�qE� I VAC�NTSIIE <br />OYES ONO <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED 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 CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. /� <br />SIGNATU/�'yy`/��` CONTRACTOR OR FUTNORIZEU AGENT OATE y a�� <br />X P'� / . �� <br />MECHANICAL <br />NC — A/HN�IG UNITS — F <br />REFRIGERATION UNITS —1 <br />BO�lERS — B.T.U.MP. <br />GAS FIRED A.C. UNITS — B. <br />FORCED AIR SYSTEMS — 8 <br />WA4l HEATERS — B.T.U. <br />UNI7 HEATERS — D.T,U. <br />LLOTHE5 DRYERS <br />VENTILATION FAN <br />RANGEHO00 <br />WATER HEATCR <br />wOOD570VE � <br />METAL FIREPLACE 8 CHIMNLY <br />FIREPLACE INSEi1T <br />HEAT PUMP <br />FAN <br />SUBTOTAL <br />� TOTALFEE <br />PLAN CHECKNUMBEH IFEE <br />BUILDING <br />PLUMBING <br />MECHAWICAL <br />OTHER <br />STAiE BUILDING SURCHARG <br />STATEENERGYSUFCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M <br />M <br />M <br />va�unnoN <br />S <br />ret <br />H[CEIPT NO. <br />PROPERN OWNERS ARE RESPONSIBIE FOB DETERMINING ALL <br />PROPERN LINE LOCATIONSAND RELATED E4SEMENTS. <br />