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�;.t' A �" <br />aPPLICATION FO�:'�� <br />'".E",°'"" CON�TRUCYION <br />cm oF <br />everett PERMIi <br />BUILDING DEPARTMENT <br />259•8810 T0 8E COMPLETED IN INK- PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />everett <br />� <br />❑ SIGN <br />•RLHIIECiONOESiGNER MRILAUDRESS - ' �"% "' '^`�^e �/�� <br />L VC� <br />GENERRLCONTNRGTOH MAILR�OqE55 G�TM Z�P PMONE LIGENSE• <br />N�-,-uv..��a���� <br />CLAS$ OF WORK <br />��NEW ❑ ADDITION C���nRN� ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSEIiT ❑ BUILDING RELUCATION <br />WOHH <br />�FY� PiPE d- �ins�k9-l� <br />GOPIESI <br />� r � lS'a�I�'�ara��Pr�� <br />-- � <br />PLUMBING <br />WATER CLOSET (TOILI <br />BATHTUB <br />UVATORY(WASH BA: <br />SNOWER <br />KITCMEN SINN d OISP. <br />OISNWRSHER <br />LAUNDRVTRAV <br />CIOTHES WASHEP <br />URINAL <br />SINK <br />iYPE OF GONST. <br />ITEM <br />ETC.) <br />SUBTOTAL S <br />PERMIT f <br />TO7AL PEE f <br />RSET6�CN S:OESETBRC <br />•REA yACANTSITE <br />OYES ONO <br />:UPANGYGROUP NO.OFDWEI <br />OF STORIE9 MRK OCC. L( <br />) ❑ VES ❑ NO <br />�NS CHEGHED BY �PPR. iOR 1: <br />:;1. ��.c�,� <br />I HERCBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOW THE SAME TO BETRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVEFNINGTHISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY f0 VIOLATE OR CANCEL THE PROVISIONS Of' <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OFCONTRACTOR OfiAUTHOflIZEO AGENT OATE <br />�`�l ,�Lk-�E?- /�a-fC�Q-7 <br />MECHANICAL <br />A/C — A/HIIDLG UNITS — H.P. <br />REFRIGERATION UNITS — H.P. EA. <br />BOILEflS — B.T.U./H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FOFCED AIR SYSTEMS — B.T.U. <br />WAIL HEATE:iS — B.T.U. <br />UNIT MEATERS — D.T.U. J7D� pp� <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEFiS <br />VENTIIATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL F�REI <br />FIREPLACEI <br />HEAT PU�:iP <br />GAS PIPING <br />PLAN CMECK NUMBER <br />S CHIMNEV <br />Sl1B TOTAI <br />PERb11T <br />TOTALFEE <br />IfEE <br />sui�oiNc <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHAFG'� <br />STATE ENEPGV SURCMAfiGE <br />PUBLIC WORKS <br />TOTAL <br />!j <br />M EA. <br />M <br />M <br />FECEIPT NO. <br />FEE <br />PROPEFTI' OWNERS ARE RESPONSIBLE FOfi �ETERMINING ALL <br />PROPEiiTY L�NE LOCATIONS AND RELATED EASENENTS. <br />