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',-�PPLICATION FC?�. �verett <br />'"'E°"°'"" CONSTRUCTION 0 <br />cin oc <br />everett PERMIT <br />BUILDING DEPARTMEN7 TO BE COMPLETED IN INK- PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWUEn M�ILAOOP[55 CITY ZIP PMONE <br />/�U'lo 1'nAU. A`�°�or AtE.� 19�J W D4�o�1 �k 7�Z A�D�1k�)JDS W(�. <br />-.--' --... _.,...... Mea eooness em ziv P ONL <br />❑ENEAALCONiR�G�OA M�Il�OURESS COY iin o��O�iE i�LENSE• <br />Of WORM <br />NEW ❑ ADDI710N ❑ AL7ERAilON ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCAT1017 <br />wonK <br />PIUMBING <br />NO. TYPE OF FI%TURE OR <br />WATER CLOSE7 �TOILETI <br />BATH7UB <br />LAVATORYIWA�HBASIN� <br />SNOWER <br />KITCHEN SINK 8 OISP <br />DISNWASHER <br />LAUN�FiV Tf1AY <br />CIGTHESIVASHEH <br />URINAI <br />na�NKING FOUNTAIN <br />ORAIN5 — � <br />�SERVICE — <br />QmiHl <br />ancliC-�iO'�eCC pv <br />ETC <br />SUBTOTAL <br />VEAMIT <br />TOTALFEE <br />SIOA�ES <br />v� t�Y. <br />S <br />f <br />f <br />SIDE SE1BnCN <br />VRCAIIT SIfE <br />OYES ONO <br />JP NO.OFOWFLLINGUNITS <br />MA% OCC LORD <br />❑ NO <br />BY PPFR FOR i55JANCF. B1 <br />� <br />���ti� lo�N _ <br />I NEREBY CERTIFY THAT I HA'YE READ AND EXAMINED TNIS AP- <br />PLICATIONAND KNOW THE SAME TO BE TRUE AND CORRECT. �Ll <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WIIL BE COMPLETEO WITH WfiETHEF SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOIATE OR CANCEL TIiE PROVISIOPIS OF <br />AN'/OTHER StATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. p Q <br />SIGNATOHEOFWNiR4CTOFOflAUTHOqIZEDAGENT DATE Q�ZI J(J� <br />^- _�s��t `� !� <br />•PPUCANiS CIfY OU9NE35 LICENIE NO <br />MECHANICAL <br />NO. TYPE OF EOUIF <br />A/C — A/HNOLG UNITS — M.P. <br />aFFRI[;FRATION UNITS — M.P. <br />BOILEPS — 9.T.V./H.r. <br />GAS FIRED A.C. UNITS — <br />FORCEO A�R SVSTEMS — <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPOFATIVECOOlERS <br />CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIfiEPLACE d CH' <br />FIREPLACEINSERT <br />HEATPUMP <br />EXHAUST <br />PLFN CHECH NUMBER <br />SUB TO7AL <br />PERMIT <br />TOTl1l FEE <br />I�� <br />eui�oir+c S <br />PLUMBING <br />MECHANICAI <br />OTHER <br />STATE BUIIDING SURCHAFGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />ITOTAL <br />� <br />� <br />FEE <br />FECEIPT NO. <br />PRUPERTYL�INELOCATONSANDNPELATEDE SEMEN7'gINGALL <br />0 <br />