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a <br />iy:�'t . : �; <br />A�PLICATION FOR � <br />'"'E""°'"" �ONSTRUCTION <br />' cirr oc <br />everett PERMI"t <br />BUILDING DEPARTMENT TO BE COMPLETED IN !NK- PLEASE PRINT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />Q,�,��Ep MAIL �DOFE55 ��N Z�P <br />Ci i� �, �-ro_�y s�Rv ic�.s,�ro S,E. E�lE2Ei •� <br />❑ PLUMBINCa <br />everen <br />e <br />PIUMBINGCONTPRCtON MAILAD�RE55 CIiY Z�P PiIONE ��CENSE• <br />Cl� OF WOHN <br />NEW ❑ ADDITION ❑ ALTEFATION ❑ REVAIF ❑ DEMOLITION ❑ WOODS70VE/fPCL.�NSEfiT ❑ BUILOING f7ELOCn1lON <br />V��URl10N OF WOjj.N �COST OF MA1ERUl5 PLUS LR90R1 <br />A p— <br />%i o <br />OESGRIBE WORN � <br />USF O� <br />io�— <br />PPOJEGT <br />PLUMBING <br />Mp, TYPE OF FI%TURE <br />W�TER CLOSET �TOILET) <br />BIITHTUB <br />LAVATORYIWASH BASIN� <br />SMOWER <br />NITCHEN SINK 8 OISP. <br />Oi5HWA5HER <br />LAUNDRV7RAY <br />CLOTMES WASHER <br />UHINAL <br />DRINKING FOUNTAIN <br />FLOOR ORA�N ' <br />BACKFIOW PREVENTERS <br />ROOF D6AINS — RAINLEAOE <br />S�NK (SERVICE — BAR. ETC.) <br />. � <br />� fRON15EiBRCK--_ <br />/ <br />USEIONE <br />� � � / <br />(YPE OF CONSi <br />� 5�2EOFBlOG <br />FIRE SPRINKLER; <br />4VPLILAI:ONAGL Ov <br />OR <br />SUB TC <br />CERMP <br />TOTAL <br />/ <br />IOTAPER <br />OF <br />I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED TfiIS AP- <br />PLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVIS�ONS OF LAWS AND ORpINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHEFl SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATU�E�OF CONTRACTOR OR AUTNORIZED AGENT OA7E <br />3 3 ti -1 1 <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />A/C — A/HNOLG UNITS — H.P. <br />HEFR�GEPATION UNITS — N.P. EA. <br />601LER5 — B.T.U./H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FORCED AIR SVSTEMS — B.T.U. M EA. <br />WALLHEATERS—B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPOAATIVE COOLERS <br />CLOTHES�RYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOOSTOVE � <br />METAL FIREFLACE d CMIMNEY <br />FIREPLACEINSEHT <br />MEATPUMP <br />GAS PIPING <br />EXHnUSTFAN <br />SIpE SETUnCK <br />VRCANT SIiE <br />OVES ONO <br />NO. OF DWEILiN <br />MR%.OGC. LORD <br />CN� IAPPR.F^ORISSI <br />I _ — <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />PLANCHECKNUMBER IFEE <br />FEE <br />RECEIPT NO. <br />BUILDING 5 <br />PLUMBING <br />MECHANICAL <br />OTHER ����0�'� <br />STATE BUILDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL Z "7 <br />PROPERNOWNERS ARE RESPOI:SIBLE FOF7 DETERAIINING ALL <br />PFOPERN LINE LOCATIONSANO RELATED EASEMEIJTS. <br />