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f c:'';7 .'��,-�::.'1 <br /> i�PPLICATION FO�:'� ���,�„ <br /> `".E"'°'"" CONSTRUCTION P, <br /> ��r oF <br /> everett PERMIT <br /> BUILDING DEPARTMENT <br /> 259•6810 TO BE COMPL.ETED IN INK• PLEASE PqINT , <br /> ❑ DEMOLITION � ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER - � • MAILA�ORE55 WfY 21P ; PMONE <br /> ic�i�niu" i �P•/�/� '� / ��.lc—/��J. '�� $�. S•r7' . [�mTl+f�/ �rPll/Z �/�7•�/�'S_ <br /> �pGNITEC?OF�D.d510NEN M�iL�ODRE55 ���� u. rn�nc <br /> � r/I K✓�l�u-s �>dv 3� .G �I-G.�iO <br /> T Plil'J'i�K !�? �rr �zc��n ���- /1L�dl,". <br /> GENERALGONTN�CTO MML�OORE55 CiTV 21P PMONE IICENSE• <br /> ,/� � y�.. ., g(L-_��.--�.'-� g' � �)-l -f 7�3 <br /> FM9n.n� C?,,,,•; ' /�IfY�/ /s� L�, /10 i�vro,� �utr S123, � <br /> MECM�NiC�LCONTP�CTOq M�ILAODHE55 UtV 21P PIIOHE ULENSE• <br /> PLUM01NaCONiR�CfOR M�IL�D�NEJS CITY EIP PIIONE LICENSE� <br /> GUSS OF WORK <br /> � NE'.� ❑ ADDITION ❑ ALTERATION ❑ REPAIF ❑ DCMOLITION ❑ WOODSTOVLIFRPL.INSERT ❑ BUILDING PELOCATION <br /> V�LU�T�OV OF W086�COST OL M�LEFIALS VLUS L�90R1 <br /> ��� i-�1y� ,�a <br /> DESCRIBE W pK <br /> �f <br /> useor auaoinc, y � .,.: ��. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> �/JAy�,�j��I PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT.ALl <br /> LEO�LO 9CRiFTlO O�PROFENTYISMUWNBEIOWOR�I7PCNFOURGOPIESI pROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> ����i �,�.�� OFWORKWILLBECOMPLETEDWITHWHETHERSPECIFIEDHERE- <br /> �ot�e�oc�.—ov IN OR NOT.THE GRANTING OF A PERMITDOES NOT PRESUME TO <br /> GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> �� N F ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> OF THE PERFORMANCE OF CONSTRUCTION. . <br /> � SIGNATUREOFCONTRRCTORORAUTMORIZEDPGENT nqTE <br /> � . � <br /> h : � � X t z r i u - �a-�7 <br /> PPOJ CT�DOHESS �PPL ANI'SCILYBl151NE55UCENSENO I <br /> `�4 . . . � . � <br /> PWMBINC MECHANICAL � � � � � • � <br /> Np, TYPE OF flIITURE OR ITEM FEE NO. TYPE OF EGUIPMEN7 FEE <br /> W�TERCLOSET�TOILET) A/C—A/MNDl6UNITS'—M.P. ' ' � <br /> �TM�B HEFRIGERATION UNITS—N.P.EA. <br /> LAVATOHY(WASH BASIN� BOILERS—B.T.U./l/.P. <br /> ���R GAS F�RED A.C.UNITS—B.Y.U. <br /> KITCHEN SINK 8 OISP. FORCEO AIR SYSTEMS—B.T.U. M EA. <br /> OISHWASMER WALLHEATERS—B.T.U. M <br /> UUNDRY��Y UNITHEATERS—B.T.U. �� I <br /> � CIOTHESWA$MER �, � ' EVAPORATIVECOOlERS � <br /> URINAL CLOTHESDHYERS � <br /> DRINKING FOUNTAIN.:1•. VENTIUITION FAN <br /> �. .fLOORDRAIN ,. '���•� RAt1GEMOOD <br /> � BACKFLOWPREVEN7ERS WATERHEATEH <br /> ROOF DPAINS—RAINIEADERS WOO�STOVE � <br /> SINK(SERVICE—BAR.ETC.) METAL FIREPUICE Q CHIMNEV <br /> • ... � FIREPLACEINSERT <br /> HEAT PUMP <br /> GAS PIPIN6 <br /> • , . , , E%MAUSTFAN <br /> SUSTOT�L f SUOTOTAL 5 <br /> iERMl7 3 PCPMIT <br /> TOTALFEE f TOTALFEE �F�O <br /> rnOHi�T�Cn RE�RSEIO�K nM'��` SiDE�9�CM� . �AN�CKN�BEi FE�� � AECEI�NO.�, � <br /> / � C G <br /> n.w <br /> USE ONE LOT�FE/A y��ANiSIfE FEES VALUATION FEE <br /> R�� //�OC�G D�YES ONO � <br /> BUILDING � <br /> TYPE OF CO��/ OGCU�NCY GROUP MO.OF pWELLING UN115 <br /> ♦ /r /hT <br /> ��3 PLUMBING (,—�[J <br /> ���G�D6. HOAF SiORIES M�X O=C�JD MECHANICAL �' i <br /> 4 /vIy <br /> OTMER <br /> FIRE SPRINKLERS REOUIRED O YES NO S7ATE BUILDING SURCHARGE (J� <br /> STATEENERGYSUFCHARGE <br /> AVV�IG�LION�CCBV PLANSCNECMEOBY �P�'0.FORISSU�NCEBY 7f \ <br /> AUBLIC WORKS (�J <br /> �� � �/ �� � TUTAL � <br /> P?.OPEFN OWNERS ARE RESPONSIBLE FOR DETEFMINING ALL <br /> FqOPERiY LINE LOCATIONS AND RELATED EASEMENTS <br />