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rn. e..ror,.n <br />cm or � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />3 <br />�i P <br />CC <br />TO BE <br />❑ DEMOLITION ❑ COMBINATION <br />OWNER M�IL �ODRES <br />NG <br />�nbm�tG�Ur+Ut: r[N MAIL��ORE55 C�IY ZIV PHONC <br />�7ilZt L �Co �! �Dt.c/ <br />GENEP�LCONfR�pif,p M�ILAOORE55 C11Y Z�v �NONE <br />Q r�.�✓ %�.t'iJ 4?2ci �ON/� (�/J .L/rl �� 5� .i � �1wnm..�� i'f30xJ 77�-0� <br />MECN�NIGLCONiIUCIOq MAIL�DDRE55 Cltt rrn ........ <br />everen <br />e <br />❑ SIGN 1 <br />!� aL NEW ❑ ADDITION �� ALiERAT10N ❑ REPMfi L DEMOLITION ❑ WOODSTOVE/FFlPL.INSERT ❑ BUILDING REIOCATION• I <br />i� V�1W110NOiWORKIf.OSIOfMM[RI�LJFWSL�OORI � <br />;.' 'y �-� /�u1 ,e�a, �S�j (�/� % <br />'� OESCRIBE WORN <br />I � <br />USE OF BUILOING <br />i <br />. LEO�L OES�q�pry pF <br />PLUMBIN6 <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET �TOILET� <br />BATFITUB <br />UVATORY IWASM BASIN� <br />KITCHEN SINK 6 DISP. <br />DISHWASMEH <br />UUNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />ROOF �RAINS — RRINLEAOERS <br />SINK �SERVICE — BRR. ETC.� <br />IPONTSEIB�CN <br />� �( <br />nve or cons*� <br />SUSTOTAL f <br />PENMIT f <br />TOTAL FEE S <br />RE�NSEIBACN'�f �� SIDE <br />i� <br />ROUP <br />R-3 <br />�11T SITE <br />5 ONO <br />OF OWFLI.ING UNITS <br />r�nnsGnL(]RtUtl� 11PPR.fOR155U�NLEAY <br />�ryV�ti � � <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINEO THIS Ap• <br />PLICATION AND KNOW THE SAME TO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILI BE COMPLETEp WITH WHETHER SPECIFIED HERE• <br />IN OR NOT THE GRANTING OF q pERM1T DOES NOT PR6SUME TO <br />GIVE AU fHORITY TO VIOLATF OR CANCEL THE PROVISIONS OF <br />ANYOTf IER STqTE OR LOCAL LA\N REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUGiION. <br />SIGNATIIpE Oi CONTii4CTOR OR AU71�pqIZEO AGENT DATE <br />/ <br />nr•vuwn rti c�rr eU9NE55 UCENSF k( <br />''� lJ/99//> u <br />MECHANICAL <br />NO. TYGE C F E�]UIVI <br />A/C — IVMNOIG U�i13 — H.P. <br />AEFPIGERATION UNITS — N.P. I <br />BOILERS — B.T.0 MP. <br />6AS F�RED A.C. UNITa — B.T.U. <br />FORCED AIR SYSTEMS — B.T.U. <br />WALL MEATERS — B T.U. <br />UNIT HEATEHS — B.T U. <br />EVAPORATIVE COOLERS <br />CLOTMES�HYERS <br />VENTILATION �AN <br />RANGEHOOD <br />� 1VATER NEATER : <br />/ WOOOSTOVE <br />L PIHEPLACE 8 CH�MNEY <br />LACEINSERT <br />PUMV <br />E%HAUSTFAN <br />PLAN CMECK NUMBER <br />SUBTOTAL <br />IKRMIi <br />TOTALFEE <br />IFEE <br />M EA. <br />M <br />M <br />'FEES VALUATION <br />BUILOING S CJ � <br />PLUMBING <br />MECHANICAL <br />OTMER P' � <br />STAiE BUILDING SURCHAFiGE <br />STATEENEFGYSURCHAPGE <br />PUBLIC 1YORKS <br />TOTAL <br />RECEIPT NO. <br />FEE <br />PROPERTYOWNERS ARE RESPONSIBLE FOR DETERA7INING ALl <br />PROPERTY LINE LOCATIONSAND RELA�EO EASEMENTS. <br />� <br />