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� <br />%PPLICATION FOf� ` <br />InsEvsrD�,�� CO N ST ft U CT I O N <br />cirr oF <br />everett PEIRMIT <br />BUILDI��G DEPARTMENT <br />259•8810 -r�, ,�,,,,fC��p„s �!�T���TO 8� COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION J�BUILDING "�(MECHANICAL <br />>Tasi�Y s SiTE WoRk 2"101� NE Pfl� <br />�. • 6UIi.DiNC�. 43rA - 2ftt AJF <br />CONiRAL10R MAIL AO�iiE55 <br />CIfV <br />everetl <br />e <br />�PLUMBING ❑SIGN <br />PMONE � g�. LU C <br />- 341dn (a21-/�4l'3-"14 <br />PMONE �Z7 �Off/�l( <br />2P�(o-P}FI(o <br />CIIONE {$OS�LI'�NZZ�.i� <br />va,�181�9, 2a3-S�� <br />PMONE UCEI�SE • <br />T� $� ��.i(�� <br />PLUMBiNaCONiRnGiOR MAILADORE55 CIiV 21P PHONE LICGNSE• <br />'lG 47C'i SP•l�'Ci`��17 <br />c,��n,/ss oF woan <br />L�'1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VnL UATION DF W OF� ILO57 OF MATE RIALS PIUS LNBORI <br />c.rr� v.lnp�c -� Gn rnr� � P� �(�DtriCi -'� 14� . l^l�0 <br />USE OF Bl11LDING <br />M71t� �RJ� (�)i�k oi� G a��' <br />L[GAL OESCRtPiiON OF PROPERTYISNOWN BEIOW Ofi RTTACH FO� <br />5'c�'�'e'�q �ccRs'S AtOi �n1 <br />io�_ eiocr�—oF <br />p.�c� VoL i2 � Pca ��9 �RD � <br />�ccEPT PcsznonLS CcNVGYE� Ta /�t"1 <br />r]till]sl? 2FMph��Y� � P�(oIDO%0 8� & <br />PROJECiADDFE55 <br />s-1.�0`� �1� � c� �:'� �Y)'a'1 I � <br />PLUNIBING UN� �,LP�. F�-2M�T <br />NO. TVPE OF FIXTl1RE OR ITEM <br />WATEP CLOSET (TOILET) <br />BATMTUB <br />� LAVATORY�WASN BASW� <br />SHOWER <br />KITCMEN SINN 6 DISP. <br />� OISHWASMER <br />� LAUNDRYTRAV _ <br />CLOTHESWASHER <br />URINAL <br />, ORINKING FOUNTAIN <br />. FLOOR ORAIN <br />BACKFIOW PREVENTERS <br />ROOF DRAINS — RAINLFJ�DERS <br />SINK (SERVICE — BAR. ETW <br />SUBTOTAL S <br />��UNi$EipACH <br />N/R <br />USE ZONE <br />G� � <br />V-r.l <br />Si2E OV' dLCG <br />oaY�n= <br />� <br />TOTALPEE S� <br />liEnRSEtBNCR SIDE <br />l2'-c�' <br />ila, 525 s, F <br />OCCl1PANCY GROUP <br />�-I /6-2 <br />NO Of STORIES <br />� W/ �s^�T <br />PLe.rvS CNECKED B` <br />�C�..J <br />i�- <br />FEE <br />N/R <br />rsire @ g� <br />❑NO ""` <br />NoNG <br />uaz occ �oao <br />3�2 <br />�, <br />APPR. FOP ISSII! NCE BY <br />�C..J <br />I HEREBY CERTIFY THAT I HA`JE READ AND EXAMINED THIS AP� <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PfiOVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE� <br />IN OR NOT. THE GRANTINCi OF A PERMIT DOES NOT PRGSUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROViS10NS OF <br />ANY OTHER STATE OR LOCAL LAW R[GULATING CONSTRUCTION <br />OR THE PERFO ANCE OF CONSTRUCTION. . <br />SIGNATURI OFCON A TGRORAUTHORIZEDAGENT OATE IZ/�r7/� <br />X 1/IYI..•I � ^ JfA /i'1r� A <br />NO <br />MECHANICAL <br />TYPE OF EdUIPMENT <br />A/C — A/HNOLG UNITS — N.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILERS — B.T.0 /H.P. <br />GAS FIRED AC. UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. <br />WAIL HEhTERS — B.T.U. <br />UNIT HEITERS — B.T.U. <br />EVAP07ATIVE COOLER'i <br />CLOTHES ORYERS <br />VENTIIATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />MEfAL FIREPLACE d CHIMNEY <br />FIREPUICE INSEPT <br />MEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />M EA. <br />M <br />M <br />FEE <br />SUBTOTAL � <br />PERMIT <br />�— TOTAL FEE f�� <br />PLAN CHEf K NUMBER FEE . C RECCIPT NO. <br />�g /a I 3 L�8 �tn_n 1 �-i � <br />FEE <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER <br />S7A7E 6UILDING SURCHARGI <br />STATF, c�:�RGY SUfiCHARGE <br />PUFLIC WORKS <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERN LINE LOCATIONS AND RELATED EASE�NENTS. <br />