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��'PLICATION FO� �����„ <br />'".E"'°'"" CQNSTRUCTION 0 <br />aTr or <br />everett PERN�IT <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION 0'i3UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />W�bCP M�II �fID11L::S \ CIIY ZIY Cr1041: <br />i,,.-r�. , L.�(�,or-7 �q.3o F 1 C�u.c i� ��9 e_ 91�2a3 3f 3-Zt t 9 <br />IAAIIA[IUIIFSti � L�1�' <br />6ENEPALLOHiF�L10R MAilnbil11E5ti Grv !iP �•��ONI. ��CL'i•:!• <br />Al]ONL5ti <br />nomrcss <br />Cllv <br />CIIY <br />a�se o� wrinn <br />❑ NEW ❑ ADDIiION ❑ ALT[PATION .� REPnIR ❑ Df.MOLI7lON ❑ wOUDSTOv[;fRP_..INSERT ❑ BUILDING RElOG1i�ON <br />v�iwnONorwonr,r,osinr�.�a��.ur<isviusuPoni � � <br />useoFeunumu I HERE�Y CERTIFV THAT 1 fIAVE READ AND EXliMINED THIS AP� <br />� PUCATIONANDKNOWTHESAMET08ETRUF.ANDCORRECTFLL <br />LCG�LOESCWNIIpNOfPqONCR� s� wHuuowon•nnr,�nom�cni•ns, PPOVISIONSOFLAWSANDORDIMqNCESGOVERNINGTHiST1'PE <br />OF N'ORI< WIIL BE COAIPLETED WITH WHETNEFl SPEGFIED HERE� <br />ioi_eioc�—o� — WORNOT.THEGRANTINGOFAPERMITDOESNQIPRESUMETO <br />GNf_ AUTHORITY TO VIOLATE OR CANCEL THE P1�t�VISIONS OF <br />ANY OTHER S7ATE OR LOCAL LAW REGULATING CONSTFlUC?i('�N <br />OR �fHE PEFFORMANCE OF CO�VSi RUCTION. ' <br />s�GNn�uPEo�'�o��nn[lononnuninnLCr,a�1[Nr D.�r�. <br />r` � ?��yi}y,-�,J1_ /%� / <br />PROJECt�00RL55 M`Pl . GfSCi1�11J::INfti51ly���F+.��i��=� / <br />J <br />PLUMBINO <br />NO. <br />WATER <br />FIXTURE OR <br />BASIN� <br />SINK 8 OISP <br />�AUNDRYTR�V <br />CIOTHES w�SHE <br />URINAL <br />URINKING FOUNI <br />FLOON ORAIN <br />BACKFIOW PRE� <br />ROOF ONAINS — <br />SINN �SEPVICE — <br />1 <br />SU0T0 <br />PERMIt <br />TOTA�I <br />�AONi$EIBACIt �E�RSEtB�( <br />VSElONF �'>>NR� <br />TYVEOfCONS� OfCUPANCv <br />S�tE OI BIDG t+n pr tirOP <br />FIRE SPRINKLENS REO"!AEO ❑ �E <br />u�o��i;a�iOt+ncC Br i�i..:�isG�E( <br />1�'1', <br />SIAE <br />V�C�Ni S11L <br />❑vE5 UNO <br />NO OF OWEIUNG <br />vor+issunHce <br />MECHANICAI <br />TYPE OF EOUIPI <br />A�C — ��MNDLG VNITS — H P <br />f1EFRIGF.PATION UNITS — H P I <br />❑OILEi18-6TU/HP <br />GA$ FIPED A C. UNITS — B.T.U. <br />FOACEO AIR SYSTEMS — B T U. <br />WnLL HEATEAS — f1 T U. <br />UNIT MGATERS — 0.T U. <br />EVAPORnTIVECOOLERS <br />CLOTHESOFYEPS <br />VENTIIATION FAN <br />RpNGEHnOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPIACE 8 CM�MNE� <br />FIPEPUICEINSENT <br />HEAT PUMP <br />GAS PIPING <br />EXF1nU5T FAN <br />�- SUlTOTAL <br />PERMIT <br />TOTAL FEE <br />1n.nN �MECK NUMOEA I FEE <br />FEES ' <br />BUILDING S <br />PLUMBING <br />MECHANICAL <br />OTt1ER <br />STATE BUILDING SURCHARGE <br />STA7EENERGVSURCHARGE <br />PUBLIC M�ORKS <br />TOTAL <br />M EA <br />M <br />M <br />RECEIPT NO. <br />PROPEHTV OWNEFS AflE RESPONSIBLE fOR DETERMINING ALL <br />PROPERTY LINE LOCATIONSAND RELA7ED [ASEMENTS. <br />